Healthcare Provider Details

I. General information

NPI: 1518313667
Provider Name (Legal Business Name): LORI ELISE SHENEP M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2016
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 S GERMANTOWN RD
GERMANTOWN TN
38138-2227
US

IV. Provider business mailing address

1211 UNION AVE STE 330
MEMPHIS TN
38104-6655
US

V. Phone/Fax

Practice location:
  • Phone: 901-432-1591
  • Fax: 901-432-1596
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number58181
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: