MEDICARE: MEHDI SHAMLOO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	01077867A	IN
2	207Q00000X	Family Medicine Physician	19520	NV
3	390200000X	Student in an Organized Health Care Education/Training Program
4	207Q00000X	Family Medicine Physician	ME169983	FL
5	207Q00000X	Family Medicine Physician	84493	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	19520	OTHER	NV	STATE LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356638811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEHDI SHAMLOO MD

Provider Business Mailing Address
First Line	:	102 WOODMONT BLVD STE 600
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37205-5250
Country	:	US
Telephone Number	:	888-987-1151
Fax Number	:

Provider Business Practice Location Address
First Line	:	5000-4 NORWOOD AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-5001
Country	:	US
Telephone Number	:	904-869-4257
Fax Number	:	855-576-4105

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2011
Last Update Date	:	06/06/2025

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Directions to “ MEHDI SHAMLOO MD” Practice Location

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