Provider Demographics
NPI:1811335920
Name:JONES-GRANDBERRY, SHAUNA RACHELLE (DRIVER)
Entity type:Individual
Prefix:MRS
First Name:SHAUNA
Middle Name:RACHELLE
Last Name:JONES-GRANDBERRY
Suffix:
Gender:F
Credentials:DRIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 MISSISSIPPI BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38126-5704
Mailing Address - Country:US
Mailing Address - Phone:901-378-6639
Mailing Address - Fax:901-948-2103
Practice Address - Street 1:940 MISSISSIPPI BLVD
Practice Address - Street 2:3898 DANTE COVE
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38126-5704
Practice Address - Country:US
Practice Address - Phone:901-378-6639
Practice Address - Fax:901-948-2103
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN070890852343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)