Supriya A Shah, MD

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

LL52600 Issued in SC

Practice address

877 W Faris Rd
Greenville, SC 29605-4289

Phone

(864) 455-9022

NPI assigned

Jun 15, 2018

Last updated

Jun 15, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1529020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529020800000",
    "number": "1689168460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "877 W FARIS RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054289",
            "telephone_number": "864-455-9022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "877 W FARIS RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054289",
            "telephone_number": "864-455-9022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "SUPRIYA",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-15",
        "last_updated": "2018-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "SC",
            "license": "LL52600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "LL52600",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Janki R Shah, M.D.
• Misty A Shah, MD
• Pavani Thotakura Shah, M.D.
• Ritesh Rajnikiant Shah, M.D.
• Sachin Shah, MD
• Tarak Shah, M.D.
• Urja Shah, DO
• Sarah Shahawy, MD
• Laurel Shaler, PHD, LISW-CP, LCSW
• David Lee Shallcross, MD

• Student in an Organized Health Care Education/Training Program in Greenville, SC
• Providers in Greenville, SC by specialty
• Student in an Organized Health Care Education/Training Program in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.