Provider Demographics
NPI:1912965500
Name:MADHOK, SHAILEE A (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAILEE
Middle Name:A
Last Name:MADHOK
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:#8 SHERIDAN SQUARE
Mailing Address - Street 2:STE 201
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660
Mailing Address - Country:US
Mailing Address - Phone:423-246-6445
Mailing Address - Fax:423-246-8240
Practice Address - Street 1:#8 SHERIDAN SQUARE
Practice Address - Street 2:STE 201
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660
Practice Address - Country:US
Practice Address - Phone:423-246-6445
Practice Address - Fax:423-246-8240
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39915174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTN0104OtherJOHN DEERE HEALTH
TN4114615OtherBLUE CROSS/BLUE SHIELD
VA192130OtherANTHEM BCBS
TNP00419964OtherRAILROAD MEDICARE
TN3335080Medicaid
TNTN0104OtherJOHN DEERE HEALTH
TN3335080Medicare ID - Type UnspecifiedTN MEDICARE PROVIDER #