Healthcare Provider Details

I. General information

NPI: 1508807215
Provider Name (Legal Business Name): SHANNON M TIGHE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 11/27/2023
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8150 OAKLANDON ROAD SUITE 130
INDIANAPOLIS IN
46236-9554
US

IV. Provider business mailing address

6626 E 75TH ST SUITE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-7111
  • Fax: 317-621-7110
Mailing address:
  • Phone: 317-621-0868
  • Fax: 317-621-1110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01061627A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: