Healthcare Provider Details

I. General information

NPI: 1104053248
Provider Name (Legal Business Name): SHILPA TARUGU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15516 SW OSCEOLA ST
INDIANTOWN FL
34956-2818
US

IV. Provider business mailing address

2100 STANTONSBURG RD GRADUATE MEDICAL EDUCATION
GREENVILLE NC
27834-2818
US

V. Phone/Fax

Practice location:
  • Phone: 304-634-8255
  • Fax: 863-824-3472
Mailing address:
  • Phone: 252-744-3229
  • Fax: 252-744-3924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME112317
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: