Provider Demographics
NPI:1154578573
Name:STROCK, SYLVIA SHEPHERD (MD)
Entity type:Individual
Prefix:DR
First Name:SYLVIA
Middle Name:SHEPHERD
Last Name:STROCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 HARMONIA RD.
Mailing Address - Street 2:
Mailing Address - City:COMO
Mailing Address - State:MS
Mailing Address - Zip Code:38619
Mailing Address - Country:US
Mailing Address - Phone:662-487-3406
Mailing Address - Fax:
Practice Address - Street 1:4634 PEPPERTREE LANE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117
Practice Address - Country:US
Practice Address - Phone:901-682-9110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000009376208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB01781Medicare UPIN