Healthcare Provider Details

I. General information

NPI: 1114489986
Provider Name (Legal Business Name): SHIV MEHTA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 ARBORLAND WAY
GREENVILLE SC
29615-2201
US

IV. Provider business mailing address

124 ROYAL WOODS RD
COLUMBIA SC
29210-4464
US

V. Phone/Fax

Practice location:
  • Phone: 864-234-7370
  • Fax:
Mailing address:
  • Phone: 803-760-8841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number748
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: