MEDICARE: SHIRIAYAH ISRAEL RRT

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	227900000X	Registered Respiratory Therapist	7699	TN
2	227900000X	Registered Respiratory Therapist	2024038534	MO
3	227900000X	Registered Respiratory Therapist	10292	KY
4	227900000X	Registered Respiratory Therapist	RCP-6121	MS
5	227900000X	Registered Respiratory Therapist	RCP-4223	AR

General Provider Information

NPI Number	:	1619760303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRIAYAH ISRAEL RRT

Provider Business Mailing Address
First Line	:	116 MULBERRY ST
Second Line	:
City	:	MARIANNA
State	:	AR
Zip	:	72360-2034
Country	:	US
Telephone Number	:	901-483-4258
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 MULBERRY ST
Second Line	:
City	:	MARIANNA
State	:	AR
Zip	:	72360-2034
Country	:	US
Telephone Number	:	817-495-3801
Fax Number	:	817-495-3801

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

Provider Enumeration Date	:	05/26/2025
Last Update Date	:	05/26/2025

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Directions to “ SHIRIAYAH ISRAEL RRT” Practice Location

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