Provider Demographics
NPI:1730132788
Name:NATARAJAN, SHIVA SHANKAR
Entity type:Individual
Prefix:
First Name:SHIVA
Middle Name:SHANKAR
Last Name:NATARAJAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7645 WOLF RIVER CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1751
Mailing Address - Country:US
Mailing Address - Phone:901-405-0275
Mailing Address - Fax:901-922-6840
Practice Address - Street 1:7645 WOLF RIVER CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1751
Practice Address - Country:US
Practice Address - Phone:901-405-0275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0319742084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR152654001Medicaid
16568OtherTLC
620903564OtherVESTICA/OMNICARE
AR98965OtherBCBS OF ARKANSAS
2075825OtherUNITED HEALTHCARE
339702002OtherCIGNA
TN3857230Medicaid
TN4170697OtherBC BS TN
7701233OtherAETNA
MS00123843Medicaid
MS00123843Medicaid
AR98965OtherBCBS OF ARKANSAS
MS130000252Medicare ID - Type UnspecifiedMISSISSIPPI MEDICARE
TN3857230Medicaid