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General NPI Number Information
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NPI Number | 1548126774
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Entity Type | Individual
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Provider Name | TANISHA A SHEPHERD
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Gender | Female
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Dates
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Enumeration Date | 12/31/2025
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Last Update Date | 12/31/2025
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Provider Practice Location Address
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Address Line | 501 GATEWAY DR STE 104
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City | CLAYTON
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State | NC
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Zip | 27520-2278
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Country | US
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Telephone | 919-550-9355
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Fax |
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Provider Business Mailing Address
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Address Line | 1040 COVE CIR
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City | CLAYTON
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State | NC
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Zip | 27520-5977
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Country | US
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Telephone | 919-631-4271
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 17738
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License Number State | NC
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