Provider Demographics
NPI:1588862445
Name:OST, SHELLEY RAE (MD)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:RAE
Last Name:OST
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8040 WOLF RIVER BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1773
Mailing Address - Country:US
Mailing Address - Phone:901-227-7900
Mailing Address - Fax:
Practice Address - Street 1:8040 WOLF RIVER BLVD STE 102
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1773
Practice Address - Country:US
Practice Address - Phone:901-227-7900
Practice Address - Fax:901-227-7920
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44120208000000X, 207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program