Individual
TYLER RESHADRICH-SHAURICE SHACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5914
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5914
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
33326
MS
Other
Enumeration date
03/27/2019
Last updated
08/08/2025
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