Provider Demographics
NPI:1376550582
Name:SHENOY, KATAPADI SURENDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:KATAPADI
Middle Name:SURENDRA
Last Name:SHENOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1859 NORTH PARIS AVENUE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:PORT ROYAL
Mailing Address - State:SC
Mailing Address - Zip Code:29935-2047
Mailing Address - Country:US
Mailing Address - Phone:843-524-2002
Mailing Address - Fax:843-524-2002
Practice Address - Street 1:1859 NORTH PARIS AVENUE
Practice Address - Street 2:SUITE 212
Practice Address - City:PORT ROYAL
Practice Address - State:SC
Practice Address - Zip Code:29935-2047
Practice Address - Country:US
Practice Address - Phone:843-524-2002
Practice Address - Fax:843-524-3522
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11315207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC113157Medicaid
SCD17574Medicare UPIN
SC113157Medicaid