Provider Demographics
NPI:1891060570
Name:STONE, PHYLANTYNIESE LASHUNDA
Entity Type:Individual
Prefix:
First Name:PHYLANTYNIESE
Middle Name:LASHUNDA
Last Name:STONE
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 1:2960 CHELSEA AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38108-1712
Mailing Address - Country:US
Mailing Address - Phone:901-216-5437
Mailing Address - Fax:
Practice Address - Street 1:2790 N. WATKINS
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127
Practice Address - Country:US
Practice Address - Phone:901-216-4711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-14
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN075640005343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)