Provider Demographics
NPI:1467951475
Name:MILLER, SHAUNDRA LASHAE
Entity Type:Individual
Prefix:
First Name:SHAUNDRA
Middle Name:LASHAE
Last Name:MILLER
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 1:1378 RIDGEWAY ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38106-4726
Mailing Address - Country:US
Mailing Address - Phone:901-254-4230
Mailing Address - Fax:
Practice Address - Street 1:1378 RIDGEWAY ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38106-4726
Practice Address - Country:US
Practice Address - Phone:901-254-4230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-05
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN82-4166790251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health