MEDICARE: SHANE ASHLEY HAYES D.O.M.,L.AC

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	171100000X	Acupuncturist	TN432	TN

General Provider Information

NPI Number	:	1619550704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANE ASHLEY HAYES D.O.M.,L.AC

Provider Business Mailing Address
First Line	:	108 HARDING PL STE 202
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37205-3704
Country	:	US
Telephone Number	:	615-622-4566
Fax Number	:	615-622-4569

Provider Business Practice Location Address
First Line	:	108 HARDING PL STE 202
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37205-3704
Country	:	US
Telephone Number	:	615-622-4566
Fax Number	:	615-622-4569

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

Provider Enumeration Date	:	05/05/2021
Last Update Date	:	06/04/2021

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