Provider Demographics
NPI:1609031608
Name:ELSHENAWY, YASMIN M (MD)
Entity Type:Individual
Prefix:
First Name:YASMIN
Middle Name:M
Last Name:ELSHENAWY
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 1:2400 SUSANNAH ST STE A
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-1730
Mailing Address - Country:US
Mailing Address - Phone:423-283-4734
Mailing Address - Fax:423-283-4736
Practice Address - Street 1:2400 SUSANNAH ST STE A
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601
Practice Address - Country:US
Practice Address - Phone:423-283-4734
Practice Address - Fax:423-283-4736
Is Sole Proprietor?:No
Enumeration Date:2008-07-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD000049476207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ001467Medicaid