Provider Demographics
NPI:1609835909
Name:HAYDEN, SHAWN JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:JOSEPH
Last Name:HAYDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1478 GOODBAR AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-4911
Mailing Address - Country:US
Mailing Address - Phone:901-454-5117
Mailing Address - Fax:901-454-1799
Practice Address - Street 1:1750 MADISON AVE STE 130
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-6428
Practice Address - Country:US
Practice Address - Phone:901-899-5010
Practice Address - Fax:901-899-5011
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD30962207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1525288Medicaid
TNG87934Medicare UPIN