Healthcare Provider Details

I. General information

NPI: 1669177002
Provider Name (Legal Business Name): NIROSHA ADEPU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MEDICAL PARK RD
COLUMBIA SC
29203-6808
US

IV. Provider business mailing address

2 MEDICAL PARK RD
COLUMBIA SC
29203-6808
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-6956
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberLL90026
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: