Provider Demographics
NPI:1356398432
Name:SHIDHAYE, NAMRATA M (MD)
Entity type:Individual
Prefix:
First Name:NAMRATA
Middle Name:M
Last Name:SHIDHAYE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-545-5014
Mailing Address - Fax:803-255-3451
Practice Address - Street 1:10040 TWO NOTCH RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-4396
Practice Address - Country:US
Practice Address - Phone:803-788-1153
Practice Address - Fax:803-933-3045
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC27439207Q00000X
NC2012-01424207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I21221Medicare UPIN