Provider Demographics
NPI:1588690168
Name:MISHRA, SUSHRI M (MD)
Entity type:Individual
Prefix:
First Name:SUSHRI
Middle Name:M
Last Name:MISHRA
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 1:210 FRANKLIN RD
Mailing Address - Street 2:SUITE 4-B
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-3218
Mailing Address - Country:US
Mailing Address - Phone:615-964-6160
Mailing Address - Fax:615-964-6120
Practice Address - Street 1:6748 CHARLOTTE PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-3720
Practice Address - Country:US
Practice Address - Phone:615-647-9005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36632207Q00000X, 207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4064788Medicaid
TN1512238Medicaid
TN4064788Medicaid
TN1512238Medicaid