Healthcare Provider Details

I. General information

NPI: 1669552493
Provider Name (Legal Business Name): PATRICIA SHIUY MONTGOMERY LCSW RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS PATRICIA ANN SHIUY

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1835 UNION AVENUE SUITE 315
MEMPHIS TN
38104-3949
US

IV. Provider business mailing address

1835 UNION AVENUE SUITE 315
MEMPHIS TN
38104-3949
US

V. Phone/Fax

Practice location:
  • Phone: 901-726-1284
  • Fax: 901-726-4396
Mailing address:
  • Phone: 901-726-1284
  • Fax: 901-726-4396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4113
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number129874
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: