Provider Demographics
NPI:1407865330
Name:SANDRAPATY, KIRAN K (MD)
Entity type:Individual
Prefix:
First Name:KIRAN
Middle Name:K
Last Name:SANDRAPATY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3106 DEVINE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-1846
Mailing Address - Country:US
Mailing Address - Phone:803-252-2255
Mailing Address - Fax:803-252-5436
Practice Address - Street 1:3106 DEVINE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-1846
Practice Address - Country:US
Practice Address - Phone:803-252-2255
Practice Address - Fax:803-252-5436
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29291208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCI60488Medicare UPIN
SCAA15268167Medicare PIN