Healthcare Provider Details

I. General information

NPI: 1366332223
Provider Name (Legal Business Name): SHREEYA THAPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 N WASHINGTON ST
SUMTER SC
29150-4949
US

IV. Provider business mailing address

180 LEE AVE
HICKSVILLE NY
11801-5844
US

V. Phone/Fax

Practice location:
  • Phone: 803-774-4500
  • Fax:
Mailing address:
  • Phone: 646-267-4561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP136062
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberLL96944
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: