Provider Demographics
NPI:1235726472
Name:LEVY SEIGEL, SHANNA GABRIELLE FISHER (CGC)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:GABRIELLE FISHER
Last Name:LEVY SEIGEL
Suffix:
Gender:F
Credentials:CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4558 KINGS GRANT DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-3428
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 HUMPHREYS CENTER DR STE 23
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2369
Practice Address - Country:US
Practice Address - Phone:901-227-6000
Practice Address - Fax:901-226-0364
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
170300000X
TN407170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS