Provider Demographics
NPI:1386800761
Name:SHYAMALAN, NELLIATE CURUNDADATH (MD 034370L PA)
Entity type:Individual
Prefix:MR
First Name:NELLIATE
Middle Name:CURUNDADATH
Last Name:SHYAMALAN
Suffix:
Gender:M
Credentials:MD 034370L PA
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Mailing Address - Street 1:132 OLD GULPH ROAD
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-1017
Mailing Address - Country:US
Mailing Address - Phone:610-649-0633
Mailing Address - Fax:610-649-5010
Practice Address - Street 1:132 OLD GULPH ROAD
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-1017
Practice Address - Country:US
Practice Address - Phone:610-649-0633
Practice Address - Fax:610-649-5010
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD - 034370L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B38116Medicare UPIN