Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 40734 | SC |
NPI | 1003234451 |
---|---|
Provider Name | Shruti Puri |
First Address | Charlotte, NC 28275-1461 |
Second Address | Charleston, SC 29425-1304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2014 |
Last Update Date | 02/08/2019 |