Provider Demographics
NPI:1396836409
Name:ROSE, SHEENA ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHEENA
Middle Name:ELIZABETH
Last Name:ROSE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 EXETER ROAD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138
Mailing Address - Country:US
Mailing Address - Phone:901-759-0984
Mailing Address - Fax:662-838-6724
Practice Address - Street 1:1922 EXETER ROAD
Practice Address - Street 2:SUITE 106
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138
Practice Address - Country:US
Practice Address - Phone:901-759-0984
Practice Address - Fax:662-838-6724
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP839103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3008998Medicaid
44706OtherNATIONAL REGISTER
R95577Medicare UPIN
TN3008998Medicaid