Provider Demographics
NPI:1457460784
Name:SHAHBAZI, SHIRIN (MD)
Entity Type:Individual
Prefix:
First Name:SHIRIN
Middle Name:
Last Name:SHAHBAZI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 E EMERALD AVE
Mailing Address - Street 2:SUITE 713
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-4539
Mailing Address - Country:US
Mailing Address - Phone:865-544-1345
Mailing Address - Fax:865-544-1344
Practice Address - Street 1:930 E EMERALD AVE
Practice Address - Street 2:SUITE 713
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-4539
Practice Address - Country:US
Practice Address - Phone:865-544-1345
Practice Address - Fax:865-544-1344
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18935207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3731585Medicaid
3036333Medicare ID - Type Unspecified
TN3731585Medicaid