Individual provider Active NPI

Shondolyn Sanders, PHD

  • Clinical Psychologist
  • Memphis, TN
National Provider Identifier
1952661522
Registry record updated Feb 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
3727 Issued in TN
Practice address
6401 Poplar Ave Ste 610
Memphis, TN 38119-4806
Phone
(901) 227-5045
NPI assigned
May 16, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X
Clinical Psychologist 103TC0700X 3727 TN Primary

Addresses

Primary practice location

6401 Poplar Ave Ste 610
Memphis, TN 38119-4806

Mailing address

965 Ridge Lake Blvd
Memphis, TN 38120-9401
Phone (901) 227-4692

Other practice location 1

7736 Airways Blvd
Southaven, MS 38671-5306
Phone (662) 772-3719

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, MS2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20201026000681 TN Practitioner - Clinical Psychologist 6608296918 Reassigns benefits to 1 organization
I20241119002731 MS Practitioner - Clinical Psychologist 6608296918 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
3727TNMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Memorial Medical Group Inc CurrentSince Apr 1, 2024 Accepting new patients
Baptist Memorial Medical Group Inc CurrentSince Apr 1, 2024 Accepting new patients

Locations

255 Baptist Blvd
Ste 301
Columbus, MS 39705
Phone (662) 244-2288

7736 Airways Blvd
Southaven, MS 38671
Phone (662) 772-3700

36 Capital Way
Ste E
Atoka, TN 38004
Phone (901) 837-6801

6401 Poplar Ave
Ste 610
Memphis, TN 38119
Phone (901) 227-5045

965 Ridge Lake Blvd
Memphis, TN 38120

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1337126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707091200000",
    "number": "1952661522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "965 RIDGE LAKE BLVD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381209401",
            "telephone_number": "901-227-4692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6401 POPLAR AVE STE 610",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381194806",
            "telephone_number": "901-227-5045"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7736 Airways Blvd",
            "address_purpose": "LOCATION",
            "city": "Southaven",
            "state": "MS",
            "postal_code": "386715306",
            "country_code": "US",
            "telephone_number": "662-772-3719",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANDERS",
        "first_name": "SHONDOLYN",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-16",
        "last_updated": "2024-02-05",
        "certification_date": "2024-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TN",
            "license": "3727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.