Healthcare Provider Details

I. General information

NPI: 1629968987
Provider Name (Legal Business Name): ABDOLRAZAGH HASHEMI SHAHRAKI PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/08/2025
Certification Date: 06/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 HART LN
NASHVILLE TN
37216-2625
US

IV. Provider business mailing address

630 HART LN
NASHVILLE TN
32216-7241
US

V. Phone/Fax

Practice location:
  • Phone: 615-499-0072
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number20236535
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: