Provider Demographics
NPI:1679146427
Name:SENTINEL HEALTHCARE TN
Entity type:Organization
Organization Name:SENTINEL HEALTHCARE TN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIRAV
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-760-5313
Mailing Address - Street 1:PO BOX 13308
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85216-3308
Mailing Address - Country:US
Mailing Address - Phone:480-335-1865
Mailing Address - Fax:914-663-5152
Practice Address - Street 1:1779 KIRBY PKWY # 18009
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38138-3666
Practice Address - Country:US
Practice Address - Phone:480-335-1865
Practice Address - Fax:914-497-3786
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SENTINEL HEALTHCARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-20
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty