Provider Demographics
NPI:1275244238
Name:RIDER, SHEA
Entity Type:Individual
Prefix:
First Name:SHEA
Middle Name:
Last Name:RIDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 N CEDAR BLUFF RD STE 305
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-3648
Mailing Address - Country:US
Mailing Address - Phone:865-888-5818
Mailing Address - Fax:865-888-5819
Practice Address - Street 1:408 N CEDAR BLUFF RD STE 305
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-3648
Practice Address - Country:US
Practice Address - Phone:865-888-5818
Practice Address - Fax:865-888-5819
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator