Provider Demographics
NPI:1164455697
Name:DAS, SHIBENDRA
Entity Type:Individual
Prefix:DR
First Name:SHIBENDRA
Middle Name:
Last Name:DAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 171181
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38187-1181
Mailing Address - Country:US
Mailing Address - Phone:901-682-2872
Mailing Address - Fax:
Practice Address - Street 1:6005 PARK AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5202
Practice Address - Country:US
Practice Address - Phone:901-682-2872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD6938207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05789561OtherMISSISSIPPI MEDICAID
TN2040383OtherUNITED HEALTHCARE
TN3149494Medicaid
TN2005233OtherBLUE CROSS
TNB59222OtherHEALTHSPRING
TN000000150607OtherBETTER HEALTH
TN9099OtherTLC
050051852OtherRR MEDICARE
TN3149494Medicaid
MS05789561OtherMISSISSIPPI MEDICAID