Provider Demographics
NPI:1760484414
Name:SHETTY, SHASHIREKHA K (MD)
Entity Type:Individual
Prefix:DR
First Name:SHASHIREKHA
Middle Name:K
Last Name:SHETTY
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 1:100 COVEY DR STE 310
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-5663
Mailing Address - Country:US
Mailing Address - Phone:615-203-8750
Mailing Address - Fax:615-472-8588
Practice Address - Street 1:100 COVEY DR STE 310
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-5663
Practice Address - Country:US
Practice Address - Phone:615-203-8750
Practice Address - Fax:866-854-5230
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41815208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ002189Medicaid
TN5441454Medicaid
IL036112986Medicaid
I34459Medicare UPIN
202I377595Medicare PIN