Provider Demographics
NPI:1851433379
Name:SWAIN, SHYAM SUNDAR (MD)
Entity Type:Individual
Prefix:
First Name:SHYAM
Middle Name:SUNDAR
Last Name:SWAIN
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 1:7105 MARINER BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-1048
Mailing Address - Country:US
Mailing Address - Phone:352-596-1339
Mailing Address - Fax:352-596-8772
Practice Address - Street 1:7105 MARINER BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-1048
Practice Address - Country:US
Practice Address - Phone:352-596-1339
Practice Address - Fax:352-596-8772
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0069790208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250540100Medicaid
32313BMedicare ID - Type Unspecified