Healthcare Provider Details

I. General information

NPI: 1700929429
Provider Name (Legal Business Name): SHADIA NOVA SISK MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 11/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 COUNTY SERVICES RD SUITE 1
ASHLAND CITY TN
37015
US

IV. Provider business mailing address

7204 S COLONY DR
NASHVILLE TN
37221-3931
US

V. Phone/Fax

Practice location:
  • Phone: 615-517-9417
  • Fax:
Mailing address:
  • Phone: 615-957-6936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: