Healthcare Provider Details

I. General information

NPI: 1457093643
Provider Name (Legal Business Name): SHANNON IVORY ROSE ALLPHIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 PATTERSON STREET
NASHVILLE TN
37203
US

IV. Provider business mailing address

1301 CONCORD TER
SUNRISE FL
33323-2843
US

V. Phone/Fax

Practice location:
  • Phone: 615-342-1000
  • Fax:
Mailing address:
  • Phone: 954-692-7673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number75699
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: