MEDICARE: DR. CHANJUAN SHI M.D., PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	MD0000046051	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	103I228107	OTHER		TENNESSEE MEDICARE NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356493944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHANJUAN SHI M.D., PH.D.

Provider Business Mailing Address
First Line	:	1161 21ST AVE S
Second Line	:	C3321A MCN
City	:	NASHVILLE
State	:	TN
Zip	:	37232-2561
Country	:	US
Telephone Number	:	615-936-8342
Fax Number	:

Provider Business Practice Location Address
First Line	:	1161 21ST AVE S
Second Line	:	C3321A MCN
City	:	NASHVILLE
State	:	TN
Zip	:	37232-2561
Country	:	US
Telephone Number	:	615-936-8342
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	09/06/2012

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Directions to “ DR. CHANJUAN SHI M.D., PH.D.” Practice Location

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