Healthcare Provider Details

I. General information

NPI: 1699588384
Provider Name (Legal Business Name): SHAMEIKA SHARNEICE TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 PARK AVE
MEMPHIS TN
38119-5198
US

IV. Provider business mailing address

5959 PARK AVE
MEMPHIS TN
38119-5198
US

V. Phone/Fax

Practice location:
  • Phone: 901-765-1000
  • Fax:
Mailing address:
  • Phone: 901-765-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number38702
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: