Provider Demographics
NPI:1528365426
Name:CHIRRAVOORI, SHYAM (MBBS MD)
Entity type:Individual
Prefix:DR
First Name:SHYAM
Middle Name:
Last Name:CHIRRAVOORI
Suffix:
Gender:M
Credentials:MBBS MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 PARK CIR
Mailing Address - Street 2:#316
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-4158
Mailing Address - Country:US
Mailing Address - Phone:803-237-5741
Mailing Address - Fax:
Practice Address - Street 1:1600 PARK CIR
Practice Address - Street 2:# 316
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-4158
Practice Address - Country:US
Practice Address - Phone:803-237-5741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-12
Last Update Date:2011-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ9851207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology