Provider Demographics
NPI:1285682211
Name:MOHYUDDIN, SHUAIB M (MD)
Entity Type:Individual
Prefix:
First Name:SHUAIB
Middle Name:M
Last Name:MOHYUDDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:510 RECOVERY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4878
Mailing Address - Country:US
Mailing Address - Phone:615-833-7080
Mailing Address - Fax:615-833-3163
Practice Address - Street 1:510 RECOVERY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4878
Practice Address - Country:US
Practice Address - Phone:615-833-7080
Practice Address - Fax:615-833-3163
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN28385207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
3804241Medicare ID - Type Unspecified
G09151Medicare UPIN