Provider Demographics
NPI:1740252642
Name:SHU TANGYIE, GERARD Y (MD)
Entity type:Individual
Prefix:DR
First Name:GERARD
Middle Name:Y
Last Name:SHU TANGYIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 SUNNYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7867
Mailing Address - Country:US
Mailing Address - Phone:615-834-2091
Mailing Address - Fax:
Practice Address - Street 1:1804 STATE ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2206
Practice Address - Country:US
Practice Address - Phone:615-321-2005
Practice Address - Fax:615-321-2035
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26159207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3086927Medicaid
TN3086927Medicaid