Individual
DR. SHYAM KOMANDUR
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
101 ROBESON ST, SUITE 300, FAYETTEVILLE, NC 28301-5552
(910) 609-1616
(910) 609-1619
Mailing address
PO BOX 41209, FAYETTEVILLE, NC 28309-1209
(910) 609-6448
(910) 609-7040
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
96-00975
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8950040
—
NC
Enumeration date
08/22/2005
Last updated
07/09/2007
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