Healthcare Provider Details

I. General information

NPI: 1710220231
Provider Name (Legal Business Name): ALEXANDRA LEE SCHALLER D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 ADAMS AVE
MEMPHIS TN
38103-2816
US

IV. Provider business mailing address

5885 AIRLINE RD UNIT 1011
ARLINGTON TN
38002-5122
US

V. Phone/Fax

Practice location:
  • Phone: 901-287-6112
  • Fax:
Mailing address:
  • Phone: 901-317-7360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number3083
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberK211150836404
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number3083
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: