Provider Demographics
NPI:1679072722
Name:SIMS, SHENIQUA (MT)
Entity Type:Individual
Prefix:MS
First Name:SHENIQUA
Middle Name:
Last Name:SIMS
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5552 WAGON ROAD GAP
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-6630
Mailing Address - Country:US
Mailing Address - Phone:901-277-7675
Mailing Address - Fax:
Practice Address - Street 1:2032 SYCAMORE VIEW RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-6669
Practice Address - Country:US
Practice Address - Phone:901-213-4776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5591225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist