Provider Demographics
NPI:1013558105
Name:GRAY, SHELIA A
Entity Type:Individual
Prefix:
First Name:SHELIA
Middle Name:A
Last Name:GRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9609 GRAYS LAKE CV
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-7770
Mailing Address - Country:US
Mailing Address - Phone:901-786-2963
Mailing Address - Fax:901-758-8374
Practice Address - Street 1:9609 GRAYS LAKE CV
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-7770
Practice Address - Country:US
Practice Address - Phone:901-786-2963
Practice Address - Fax:901-758-8374
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker