Provider Demographics
NPI:1184061509
Name:SHETE EAR NOSE & THROAT CLINIC, PLLC
Entity type:Organization
Organization Name:SHETE EAR NOSE & THROAT CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHETE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-644-2857
Mailing Address - Street 1:PO BOX 17304
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38187-0304
Mailing Address - Country:US
Mailing Address - Phone:901-644-2857
Mailing Address - Fax:901-844-3222
Practice Address - Street 1:5100 SANDERLIN AVE
Practice Address - Street 2:SUITE 1200
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4387
Practice Address - Country:US
Practice Address - Phone:901-644-2857
Practice Address - Fax:901-844-3222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-24
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN49192207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
103G709378Medicare PIN