Provider Demographics
NPI:1710181201
Name:SHABA, CASEY ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:ELIZABETH
Last Name:SHABA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:ELIZABETH
Other - Last Name:WILFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-239-2018
Mailing Address - Fax:
Practice Address - Street 1:4230 HARDING PIKE STE 703A
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2013
Practice Address - Country:US
Practice Address - Phone:615-467-4638
Practice Address - Fax:615-467-4639
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN47062207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology