Healthcare Provider Details

I. General information

NPI: 1174071070
Provider Name (Legal Business Name): MIYOKO FUJII PATRICELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 S HOLLYWOOD ST
MEMPHIS TN
38112-4801
US

IV. Provider business mailing address

160 S HOLLYWOOD ST
MEMPHIS TN
38112-4801
US

V. Phone/Fax

Practice location:
  • Phone: 901-416-5300
  • Fax:
Mailing address:
  • Phone: 901-416-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6018
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: