# RUPA SHETTY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205137817
- **Authorized official:** MR. THOMAS L RYBA (MEMBER)
- **Authorized official phone:** (843) 461-6133

## Contact information

- **Practice address:** 237 AVENUE OF THE PALMS, MYRTLE BEACH, SC 29579-1247
- **Practice address phone:** (843) 461-6133
- **Practice address fax:** (843) 234-6100
- **Mailing address:** 237 AVENUE OF THE PALMS, MYRTLE BEACH, SC 29579-1247
- **Mailing address phone:** (843) 461-6133
- **Mailing address fax:** (843) 234-6100

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084P0804X | Child & Adolescent Psychiatry Physician | 27604 | SC | Yes |

## Other

- **Enumeration date:** 11/12/2010
- **Last updated:** 08/09/2011