Provider Demographics
NPI:1013086735
Name:SHULTS, STEPHANIE STAPLETON (MD)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:STAPLETON
Last Name:SHULTS
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 1:1275 DICK LONAS RD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1383
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-670-1862
Practice Address - Street 1:9142 S NORTHSHORE DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-6325
Practice Address - Country:US
Practice Address - Phone:865-670-1560
Practice Address - Fax:865-670-1862
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24906208000000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3087409Medicaid
TN3087408Medicare ID - Type Unspecified
TNF95041Medicare UPIN