Provider Demographics
NPI:1669693271
Name:SHEPPARD, EMILY MAYO (DDS)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:MAYO
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 EASTBOURNE PLACE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117
Mailing Address - Country:US
Mailing Address - Phone:901-452-9489
Mailing Address - Fax:
Practice Address - Street 1:6565 STAGE RD STE 2
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-3830
Practice Address - Country:US
Practice Address - Phone:901-382-0280
Practice Address - Fax:901-791-0955
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8667122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ013685Medicaid