Provider Demographics
NPI:1528477007
Name:BONDS-SINGLETON, SHANDEIDRA NICOLE (MD)
Entity type:Individual
Prefix:
First Name:SHANDEIDRA
Middle Name:NICOLE
Last Name:BONDS-SINGLETON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 SKYLINE DR DEPT OF
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3903
Mailing Address - Country:US
Mailing Address - Phone:615-327-6284
Mailing Address - Fax:615-327-6296
Practice Address - Street 1:657 SKYLINE DR DEPT OF
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3903
Practice Address - Country:US
Practice Address - Phone:615-327-6284
Practice Address - Fax:615-327-6296
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN58521207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty