Healthcare Provider Details

I. General information

NPI: 1518307578
Provider Name (Legal Business Name): ANITRA DANIELLE SHELTON-QUINN PHD/HSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2013
Last Update Date: 07/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 AIRWAYS BLVD
MEMPHIS TN
38116-3844
US

IV. Provider business mailing address

2930 AIRWAYS BLVD
MEMPHIS TN
38116-3844
US

V. Phone/Fax

Practice location:
  • Phone: 832-226-7355
  • Fax:
Mailing address:
  • Phone: 832-226-7355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number3098
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: