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General NPI Number Information
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NPI Number | 1740448067
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Entity Type | Individual
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Provider Name | RITA R. SHRIDHARANI MD
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Gender | Female
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Dates
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Enumeration Date | 05/23/2008
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Last Update Date | 08/17/2015
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Provider Practice Location Address
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Address Line | 910 BLACKFORD ST
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City | CHATTANOOGA
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State | TN
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Zip | 37403-1405
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Country | US
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Telephone | 423-778-6405
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Fax | 423-778-2096
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Provider Business Mailing Address
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Address Line | 975 E 3RD ST ATTN: PROVIDER ENROLLMENT
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City | CHATTANOOGA
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State | TN
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Zip | 37403-2147
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Country | US
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Telephone | 423-778-3110
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Fax | 423-778-3146
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0205X
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Taxonomy Name | Pediatric Endocrinology Physician
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License Number | 52861-20
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 52681-20
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 50122
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 2080P0205X
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Taxonomy Name | Pediatric Endocrinology Physician
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License Number | 50122
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License Number State | TN
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