Provider Demographics
NPI:1912753179
Name:CHAMPANERIA, SHIVAM UMESH (MD)
Entity Type:Individual
Prefix:
First Name:SHIVAM
Middle Name:UMESH
Last Name:CHAMPANERIA
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 1:2215 GARLAND AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-0687
Mailing Address - Country:US
Mailing Address - Phone:615-322-4916
Mailing Address - Fax:615-343-1496
Practice Address - Street 1:2215 GARLAND AVE STE 203
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0019
Practice Address - Country:US
Practice Address - Phone:615-322-4916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-29
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program