Shahla Amjad Kaukab, M.D.
Individual provider Active NPI Pediatrics Physician · Soddy Daisy, TN
NPI 1699703264 · NPPES record last updated Jun 1, 2026
Key facts
- NPI
- 1699703264
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 37633 (TN)
- Practice address
- 9089 Dayton Pike
Soddy Daisy, TN 37379 - Phone
- (423) 451-0623
- Fax
- (423) 451-0624
- NPI assigned
- Jun 30, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37633 | TN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Soddy Daisy Pediatrics | Pediatrics | Past |
Accepting new patients |
| Erlanger Health | Past | Accepting new patients | |
| Soddy Daisy Family Care | Pediatrics | Past |
Accepting new patients |
| Parkridge Medical Center, Inc. | Past | Accepting new patients | |
| Soddy Daisy Medical Care | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 37633 | TN | Yes |
Addresses
Primary practice location
9089 Dayton Pike
Soddy Daisy, TN 37379
Mailing address
PO Box 1059
Soddy Daisy, TN 37384-1059
Phone (423) 451-0623
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3887638 | Medicaid | TN |
Other providers in Soddy Daisy, TN
- Jeffrey L. Brewer DDS PC
- Ashley L Johnson
- Sonya Lashawn Johnson
- Marcus Jones
- Joseph Sease DMD PLCC
- Keithcare Inc
- John Thomas Key
- Madeline Knott
- Madison Caice Land
- Loving Care Services Inc
All providers in Soddy Daisy, TN · Pediatrics Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 1, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.