MEDICARE: TIJUNA SHEPARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1744P3200X	Prosthetics Case Management	122113	TN

General Provider Information

NPI Number	:	1003351107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIJUNA SHEPARD

Provider Business Mailing Address
First Line	:	7505 US HIGHWAY 64
Second Line	:	SUITE 105
City	:	MEMPHIS
State	:	TN
Zip	:	38133-8947
Country	:	US
Telephone Number	:	901-347-2003
Fax Number	:

Provider Business Practice Location Address
First Line	:	7505 US HIGHWAY 64
Second Line	:	SUITE 105
City	:	MEMPHIS
State	:	TN
Zip	:	38133-8947
Country	:	US
Telephone Number	:	901-347-2003
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2016
Last Update Date	:	12/27/2016

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Directions to “ TIJUNA SHEPARD ” Practice Location

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