Provider Demographics
NPI:1568856011
Name:RICHARDSON, SHANDREKA
Entity Type:Individual
Prefix:
First Name:SHANDREKA
Middle Name:
Last Name:RICHARDSON
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 1:2129 S GERMANTOWN RD
Mailing Address - Street 2:224
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3844
Mailing Address - Country:US
Mailing Address - Phone:866-563-7772
Mailing Address - Fax:901-255-0758
Practice Address - Street 1:2129 S GERMANTOWN RD
Practice Address - Street 2:224
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3844
Practice Address - Country:US
Practice Address - Phone:866-563-7772
Practice Address - Fax:901-255-0758
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant