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General NPI Number Information
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NPI Number | 1346237013
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Entity Type | Individual
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Provider Name | DEVENDRA T SHANTHA M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/29/2005
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Last Update Date | 08/27/2024
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Provider Practice Location Address
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Address Line | 1325 SPRING ST
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City | GREENWOOD
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State | SC
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Zip | 29646-3860
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Country | US
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Telephone | 864-725-4111
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Fax |
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Provider Business Mailing Address
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Address Line | 706 HOLLYWOOD ST.
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City | SPARTANBURG
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State | SC
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Zip | 29302
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Country | US
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Telephone | 770-330-5684
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Fax | 864-560-6276
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 19132
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License Number State | SC
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