Healthcare Provider Details

I. General information

NPI: 1104763184
Provider Name (Legal Business Name): HALEEMA SHAMSUDDIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 MEHARRY BLVD
NASHVILLE TN
37208
US

IV. Provider business mailing address

704 DEVON WAY CT
NASHVILLE TN
37221-3015
US

V. Phone/Fax

Practice location:
  • Phone: 615-341-4397
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: