Individual
SHANNON RILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
848 ADAMS AVE, MEMPHIS, TN 38103-2816
(901) 287-6112
Mailing address
2040 W CHARLESTON BLVD STE 402, LAS VEGAS, NV 89102-2250
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
56154
TN
208000000X
Pediatrics Physician
Primary
56154
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
TN
Enumeration date
03/31/2014
Last updated
12/17/2021
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