Provider Demographics
NPI:1215934591
Name:FISHER, SHELDON H (DO)
Entity type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:H
Last Name:FISHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 BROOKSIDE DR
Mailing Address - Street 2:STE 300
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4634
Mailing Address - Country:US
Mailing Address - Phone:423-392-6370
Mailing Address - Fax:423-392-6736
Practice Address - Street 1:2002 BROOKSIDE DR
Practice Address - Street 2:STE 300
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4634
Practice Address - Country:US
Practice Address - Phone:423-392-6370
Practice Address - Fax:423-392-6736
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO700207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1215934591Medicaid
TN3301827Medicaid
TN3301827Medicaid
TN3709285Medicare UPIN
TN3301827Medicare PIN