Provider Demographics
NPI:1205214822
Name:MOORE, SHELBY LAUREN (CNIM)
Entity Type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:LAUREN
Last Name:MOORE
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:MS
Other - First Name:SHELBY
Other - Middle Name:LAUREN
Other - Last Name:BURRUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 MARYLAND FARMS STE 200
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027
Mailing Address - Country:US
Mailing Address - Phone:615-345-5400
Mailing Address - Fax:
Practice Address - Street 1:3 MARYLAND FARMS STE 200
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027
Practice Address - Country:US
Practice Address - Phone:615-345-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-14
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
No2472E0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherEEG
Provider Identifiers
StateIdentifier IDID TypeIssuer
1912171760OtherGROUP NPI