Provider Demographics
NPI:1104027960
Name:HUDEPOHL, NEHA SHROFF (MD)
Entity Type:Individual
Prefix:
First Name:NEHA
Middle Name:SHROFF
Last Name:HUDEPOHL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NEHA
Other - Middle Name:MAHESH
Other - Last Name:SHROFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:10 PATEWOOD DR STE 130
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6317
Practice Address - Country:US
Practice Address - Phone:864-455-8988
Practice Address - Fax:864-522-5555
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC823462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC823461Medicaid
RIMD13210OtherMEDICAL LICENSE