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General NPI Number Information
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NPI Number | 1851390728
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Entity Type | Individual
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Provider Name | VICTOR A SHADA D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/21/2005
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Last Update Date | 04/26/2023
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Provider Practice Location Address
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Address Line | 1264 DAYTON AVE
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City | CROSSVILLE
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State | TN
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Zip | 38555-6175
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Country | US
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Telephone | 931-484-4560
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Fax | 931-484-1480
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Provider Business Mailing Address
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Address Line | PO BOX 887
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City | CROSSVILLE
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State | TN
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Zip | 38557-0887
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Country | US
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Telephone | 931-484-4560
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Fax | 931-484-1480
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1424
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License Number State | TN
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