Healthcare Provider Details

I. General information

NPI: 1154578573
Provider Name (Legal Business Name): SYLVIA SHEPHERD STROCK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4634 PEPPERTREE LANE
MEMPHIS TN
38117
US

IV. Provider business mailing address

1190 HARMONIA RD.
COMO MS
38619
US

V. Phone/Fax

Practice location:
  • Phone: 901-682-9110
  • Fax:
Mailing address:
  • Phone: 662-487-3406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number0000009376
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: