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General NPI Number Information
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NPI Number | 1760518658
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Entity Type | Individual
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Provider Name | KENDRA DIONNE SHEPPARD MD
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Gender | Female
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 11/30/2021
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Provider Practice Location Address
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Address Line | 1056 E RAINES RD
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City | MEMPHIS
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State | TN
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Zip | 38116-6337
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Country | US
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Telephone | 901-300-5777
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Fax | 901-422-6092
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Provider Business Mailing Address
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Address Line | 1395 NW 167TH ST
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City | MIAMI GARDENS
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State | FL
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Zip | 33169-5710
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Country | US
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Telephone | 901-300-5777
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Fax | 901-422-6092
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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 | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 28922
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 28922
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 61176
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License Number State | TN
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