Healthcare Provider Details

I. General information

NPI: 1366354425
Provider Name (Legal Business Name): MRS. SHAMICO WINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 FREEDOM WOODS CV
CORDOVA TN
38018-1015
US

IV. Provider business mailing address

330 FREEDOM WOODS CV
CORDOVA TN
38018-1015
US

V. Phone/Fax

Practice location:
  • Phone: 901-201-8227
  • Fax:
Mailing address:
  • Phone: 901-201-8227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number16905
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: