Provider Demographics
NPI:1376508663
Name:JHA, SHYAM A (MD)
Entity Type:Individual
Prefix:
First Name:SHYAM
Middle Name:A
Last Name:JHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 N UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-3012
Mailing Address - Country:US
Mailing Address - Phone:615-968-7727
Mailing Address - Fax:615-467-8587
Practice Address - Street 1:528 N UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-3012
Practice Address - Country:US
Practice Address - Phone:615-968-7727
Practice Address - Fax:615-467-8587
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD26688207L00000X, 207LP2900X
TXK3764207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1507521Medicaid
TN2900592OtherCIGNA
TN1507521Medicaid