Healthcare Provider Details

I. General information

NPI: 1609564699
Provider Name (Legal Business Name): TIFFANY BURKS-SANDERS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 BEDE RD
MEMPHIS TN
38128-5302
US

IV. Provider business mailing address

2920 BEDE RD
MEMPHIS TN
38128-5302
US

V. Phone/Fax

Practice location:
  • Phone: 901-216-6962
  • Fax:
Mailing address:
  • Phone: 901-216-6962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number11397
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: