Provider Demographics
NPI:1861425001
Name:PUPPALA, SHAYM (MD)
Entity type:Individual
Prefix:DR
First Name:SHAYM
Middle Name:
Last Name:PUPPALA
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 1:2131 WOODRUFF ROAD
Mailing Address - Street 2:SUITE 2100 #127
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5959
Mailing Address - Country:US
Mailing Address - Phone:864-640-0009
Mailing Address - Fax:864-558-0589
Practice Address - Street 1:1202 E BUTLER ROAD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5910
Practice Address - Country:US
Practice Address - Phone:864-640-0009
Practice Address - Fax:864-558-0589
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31120207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC311200Medicaid
SC311200Medicaid