Healthcare Provider Details

I. General information

NPI: 1508516311
Provider Name (Legal Business Name): SHAMYA SHANNON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 24TH AVE S
NASHVILLE TN
37212-2637
US

IV. Provider business mailing address

1404 KINGBIRD DR
CLARKSVILLE TN
37040-1719
US

V. Phone/Fax

Practice location:
  • Phone: 615-873-7373
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10516
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: