Provider Demographics
NPI:1922398361
Name:MERRY-AFOAKWA, SHAYLA TANESIA (MD)
Entity Type:Individual
Prefix:
First Name:SHAYLA
Middle Name:TANESIA
Last Name:MERRY-AFOAKWA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHAYLA
Other - Middle Name:TANESIA
Other - Last Name:MERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1000 DEPT # 351
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-516-5587
Mailing Address - Fax:901-516-5323
Practice Address - Street 1:3960 NEW COVINGTON PIKE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-2504
Practice Address - Country:US
Practice Address - Phone:901-516-5587
Practice Address - Fax:901-516-5323
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN51671207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ007220Medicaid
MS06183733Medicaid
AR204727001Medicaid