SHAUN MICHAEL STICKLEY (NPI# 1528289808) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528289808 |
| Entity Type | Individual |
| Full Name | SHAUN MICHAEL STICKLEY |
| Credential | M.D. |
| Practice Address |
1325 Eastmoreland Ave Ste 310 Memphis TN 38104-7544 |
| Mailing Address |
P O Box 1000 Dept 457 Memphis TN 38148-0001 |
| Practice Telephone | 9012726010 |
| Practice Fax Number | 9012666468 |
| Mailing Telephone | 9012753662 |
| Mailing Fax Number | 9012710155 |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2018-03-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
48394 | TN | Allopathic & Osteopathic Physicians |
| N | 2086S0129X |
Surgery Specialization: Vascular Surgery |
096419 | OH | Allopathic & Osteopathic Physicians |
| Street Address |
1325 EASTMORELAND AVE STE 310 |
| City | MEMPHIS |
| State | TN |
| Zip Code | 38104-7544 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699289272 | Reona Michelle Esson | Nurse Practitioner | 1325 Eastmoreland Ave Ste 310, Memphis, TN 38104-7544 | 2017-11-19 |
| 1609304286 | Kaitlin Mcdaniel | Physician Assistant | 1325 Eastmoreland Ave Ste 310, Memphis, TN 38104-7544 | 2017-05-26 |
| 1457623258 | Alicia A Farris | Nurse Practitioner | 1325 Eastmoreland Ave Ste 310, Memphis, TN 38104-7544 | 2012-02-08 |
| 1134448269 | Carissa A Webster-lake | Surgery | 1325 Eastmoreland Ave Ste 310, Memphis, TN 38104-7544 | 2010-05-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952900367 | Christy White | Recreation Therapist | 1030 Jefferson Ave (rt117), Memphis, TN 38104 | 2020-10-19 |
| 1821615873 | Altiana Carter | Optometrist | 650 New York St, Memphis, Tn 38104, Memphis, TN 38104 | 2020-06-25 |
| 1952898413 | Family To Family Adult Care Service | Chore Provider | 1331 Union Ave Suite 1028, Mempnis, TN 38104 | 2018-04-19 |
| 1326544800 | Kimberly Vestoria Mcclinton | Nurse Practitioner | 2200 Union Ave 1, Memphis, TN 38104 | 2018-04-03 |
| 1649799339 | Benjamin Duhart Jr. | Pharmacist | 1265 Union Avenue- Methodist University Hospital, Ground Floor Pharmacy Administration, Memphis, TN 38104 | 2017-09-13 |
| 1134644982 | Amy Michelle Wise | Nurse Practitioner | 1325 Eastmoreland Ave Ste 500, Memphis, TN 38104 | 2017-08-13 |
| 1316468572 | Jinger Cathey | Social Worker | 1330 Jefferson Ave, Memphis, TN 38104 | 2017-06-28 |
| 1336669183 | Charma May Kavuncu | Social Worker | 1407 Union Ave Ste 1100, Memphis, TN 38104 | 2017-06-22 |
| 1003345398 | Angelica J Dennis | Nurse Practitioner | 1265 Union, Memphis, TN 38104 | 2017-06-08 |
| 1609302546 | Cheryl Beene | Nurse Practitioner | 1211 Union Ave Ste 475, Memphis, TN 38104 | 2017-05-11 |
| Find all providers in zip 38104 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215548375 | Center for Vein Restoration Tn Pllc | Surgery | 6005 Park Ave Ste 225b, Memphis, TN 38119-5207 | 2020-08-12 |
| 1679969729 | Jeffrey Thomas Johnston | Surgery | 910 Madison Ave Fl 2, Memphis, TN 38103-3403 | 2015-04-15 |
| 1992813158 | Larry Dale Burke | Surgery | 6025 Walnut Grove Rd Ste 311, Memphis, TN 38120-2123 | 2006-08-28 |
| 1073538823 | Jonathan J Ellichman | Surgery | 6401 Poplar Ave Ste 410, Memphis, TN 38119-4808 | 2006-07-13 |
| 1306112487 | Jorge Luis Weber Guzman | Surgery | 6025 Walnut Grove Rd Ste 301, Memphis, TN 38120-2123 | 2012-03-22 |
| 1881901163 | James Eric Gardner, Md, PC | Surgery | 1750 Madison Ave, Suite 300, Memphis, TN 38104-6492 | 2010-09-08 |
| 1952555666 | Prateek Kumar Gupta | Surgery | 1325 Eastmoreland Ave, Suite 310, Memphis, TN 38104-3519 | 2008-11-07 |
| 1770789349 | Larry Burke, Md, PC | Surgery | 6025 Walnut Grove Rd, #311, Memphis, TN 38120-2131 | 2007-06-21 |
| 1801009089 | James Eric Gardner | Surgery | 1750 Madison Ave, Suite 300, Memphis, TN 38104-6492 | 2007-05-07 |
| 1386744514 | Patricio A. Ilabaca, Md, PC | Surgery | 6027 Walnut Grove Rd, Suite 114, Memphis, TN 38120-2145 | 2006-09-25 |
| Find all providers in MEMPHIS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.