Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD0000041810 | TN |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 41810 | TN |
NPI | 1275655466 |
---|---|
Provider Name | Sara Michelle Federico |
First Address | Memphis, TN 38105-3678 |
Second Address | Memphis, TN 38105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 19/06/2018 |