Provider Demographics
NPI:1639178932
Name:ASSADNIA, SHAHIN (MD)
Entity Type:Individual
Prefix:MR
First Name:SHAHIN
Middle Name:
Last Name:ASSADNIA
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 1:1125 W 1ST NORTH ST
Mailing Address - Street 2:STE. B
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-4562
Mailing Address - Country:US
Mailing Address - Phone:423-317-6560
Mailing Address - Fax:423-317-6570
Practice Address - Street 1:1125 W 1ST NORTH ST
Practice Address - Street 2:STE. B
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-4562
Practice Address - Country:US
Practice Address - Phone:423-317-6560
Practice Address - Fax:423-317-6570
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD358812086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
4075540OtherBCBS
TN3874100Medicaid
3874100Medicare ID - Type Unspecified
TN3874100Medicaid