Provider Demographics
NPI:1861775488
Name:SANDY, TANYA PASSARELLA (DPH)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:PASSARELLA
Last Name:SANDY
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1866 NORTHCROSS PL S
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-8705
Mailing Address - Country:US
Mailing Address - Phone:901-850-1200
Mailing Address - Fax:
Practice Address - Street 1:3177 S PERKINS RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-4354
Practice Address - Country:US
Practice Address - Phone:901-365-4440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4131183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist