Healthcare Provider Details

I. General information

NPI: 1780866046
Provider Name (Legal Business Name): SHYAM YALLAPRAGADA MD, F.C.C.P.,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 TRICOM ST
NORTH CHARLESTON SC
29406-9172
US

IV. Provider business mailing address

2811 TRICOM ST
NORTH CHARLESTON SC
29406-9172
US

V. Phone/Fax

Practice location:
  • Phone: 843-572-4774
  • Fax: 843-572-2508
Mailing address:
  • Phone: 843-572-4774
  • Fax: 843-572-2508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number9767
License Number StateSC

VIII. Authorized Official

Name: DR. SHYAM YALLAPRAGADA
Title or Position: OWNER
Credential: MD
Phone: 843-572-4774