Provider Demographics
NPI:1700080298
Name:SHIBAO MIYASATO, CYNDYA ADRIANA (MD)
Entity Type:Individual
Prefix:
First Name:CYNDYA
Middle Name:ADRIANA
Last Name:SHIBAO MIYASATO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CYNDYA
Other - Middle Name:ADRIANA
Other - Last Name:SHIBAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3841 GREEN HILLS VILLAGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2691
Mailing Address - Country:US
Mailing Address - Phone:615-936-2000
Mailing Address - Fax:
Practice Address - Street 1:1215 21ST AVENUE SOUTH SUITE 5209
Practice Address - Street 2:MEDICAL CENTER EAST
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232
Practice Address - Country:US
Practice Address - Phone:615-343-1789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000045547207R00000X, 208U00000X
TNMD45547208U00000X
TN45547207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology