Provider Demographics
NPI:1629642459
Name:ROBINSON, SHANICE A
Entity Type:Individual
Prefix:
First Name:SHANICE
Middle Name:A
Last Name:ROBINSON
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 1:1811 KIRBY PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3667
Mailing Address - Country:US
Mailing Address - Phone:901-275-8321
Mailing Address - Fax:
Practice Address - Street 1:1811 KIRBY PKWY STE 1
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38138-3667
Practice Address - Country:US
Practice Address - Phone:901-275-8321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN47335183700000X
TN246RM2200X, 246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No183700000XPharmacy Service ProvidersPharmacy Technician
No246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory