Healthcare Provider Details

I. General information

NPI: 1831534015
Provider Name (Legal Business Name): SHARONDA FOSTER TAYLOR RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 05/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7459 JUNIPER RIDGE DR
MEMPHIS TN
38125-3539
US

IV. Provider business mailing address

7459 JUNIPER RIDGE DR
MEMPHIS TN
38125-3539
US

V. Phone/Fax

Practice location:
  • Phone: 901-605-1981
  • Fax:
Mailing address:
  • Phone: 901-605-1981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN0000118944
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: