Provider Demographics
NPI:1811104003
Name:CARLSON, SHILPA REDDY (DO)
Entity type:Individual
Prefix:
First Name:SHILPA
Middle Name:REDDY
Last Name:CARLSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 NORTHCREST DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-3962
Mailing Address - Country:US
Mailing Address - Phone:615-382-5732
Mailing Address - Fax:615-384-6002
Practice Address - Street 1:224 NORTHCREST DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-3962
Practice Address - Country:US
Practice Address - Phone:615-382-5732
Practice Address - Fax:615-384-6002
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2261207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1525114Medicaid
TN103I395401Medicare PIN