Provider Demographics
NPI:1902879646
Name:SHOJAIE, MARY O (CNM)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:O
Last Name:SHOJAIE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2254 LAUREL HILLS DR NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3470
Mailing Address - Country:US
Mailing Address - Phone:423-479-8416
Mailing Address - Fax:423-339-9950
Practice Address - Street 1:2301 N OCOEE ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3863
Practice Address - Country:US
Practice Address - Phone:423-339-1400
Practice Address - Fax:423-339-9950
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNAPN0000006986367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDAPN0000006986OtherCERTIFIED ADVANCE PRACTIC
TN3720806Medicare ID - Type Unspecified