Individual
DR. SANJANA IDDYADINESH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O
Contact information
Practice address
3904 S HIGHWAY 14, GREENVILLE, SC 29615-6138
(864) 987-9990
Mailing address
3904 S HIGHWAY 14, GREENVILLE, SC 29615-6138
(864) 987-9990
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2018-02717
NC
207Q00000X
Family Medicine Physician
Primary
83144
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548641871
—
NC
Enumeration date
06/11/2015
Last updated
07/19/2021
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