Provider Demographics
NPI:1710724810
Name:SALLEY, SHAMIRA
Entity type:Individual
Prefix:
First Name:SHAMIRA
Middle Name:
Last Name:SALLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13153 OLD HICKORY BLVD APT 115
Mailing Address - Street 2:
Mailing Address - City:CANE RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37013-5011
Mailing Address - Country:US
Mailing Address - Phone:615-202-9834
Mailing Address - Fax:
Practice Address - Street 1:760 N THOMPSON LN STE 14
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-4316
Practice Address - Country:US
Practice Address - Phone:615-977-1681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
TN13938225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No374J00000XNursing Service Related ProvidersDoula