Healthcare Provider Details

I. General information

NPI: 1659325587
Provider Name (Legal Business Name): SRIDHAR SHANKAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7945 WOLF RIVER BLVD
GERMANTOWN TN
38138-1762
US

IV. Provider business mailing address

7714 POPLAR AVE STE 200
GERMANTOWN TN
38138-3941
US

V. Phone/Fax

Practice location:
  • Phone: 901-683-0055
  • Fax: 901-685-2969
Mailing address:
  • Phone: 901-683-0055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number211205
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number44655
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number44655
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number59419
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: