Individual
VANESSA SEPULVEDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6215 HUMPHREYS BLVD, SUITE 200, MEMPHIS, TN 38120-2367
(901) 821-9990
(901) 821-9991
Mailing address
PO BOX 1000, DEPT 978, MEMPHIS, TN 38148-0001
(901) 821-9990
(901) 821-9991
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
28037
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00126656
—
MS
01
—
6012376
BCBS
TN
05
—
Q001728
—
TN
Enumeration date
07/08/2005
Last updated
03/03/2016
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