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Organization
SWAROOP N NYSHADHAM MD
Active
Organization
SWAROOP N NYSHADHAM MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSAN H WOOD (OFFICE MANAGER)
(334) 756-8190
Entity
Organization
Contact information
Practice address
4503 20TH AVE, VALLEY, AL 36854
(334) 756-8190
(334) 756-5158
Mailing address
4503 20TH AVE, VALLEY, AL 36854
(334) 756-8190
(334) 756-5158
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
013121
AL
208600000X
Surgery Physician
031483
GA
208600000X
Surgery Physician
ME49553
FL
208D00000X
General Practice Physician
Primary
013121
AL
208D00000X
General Practice Physician
031483
GA
208D00000X
General Practice Physician
ME49553
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000082972
—
AL
05
—
000338357B
—
AL
05
—
000338357F
—
GA
01
—
009937179
MCAID
AL
05
—
009937179
—
AL
01
—
02BDCHN01
MCARE
GA
05
—
300041350A
—
GA
01
—
51082972
BLUE CROSS
AL
01
—
51514838
BLUE CROSS
AL
01
—
51532898
BLUE CROSS
AL
05
—
529928300
—
AL
Enumeration date
02/15/2008
Last updated
02/11/2016
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