Organization
RUPA SHETTY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS L RYBA (MEMBER)
(843) 461-6133
Entity
Organization
Contact information
Practice address
237 AVENUE OF THE PALMS, MYRTLE BEACH, SC 29579-1247
(843) 461-6133
(843) 234-6100
Mailing address
237 AVENUE OF THE PALMS, MYRTLE BEACH, SC 29579-1247
(843) 461-6133
(843) 234-6100
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
27604
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3344
WACCAMAW CENTER FOR MENTAL HEALTH
SC
Enumeration date
11/12/2010
Last updated
08/09/2011
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