Provider Demographics
NPI:1942300892
Name:SWEETEN, BIANCA JUSELLE (MD)
Entity type:Individual
Prefix:DR
First Name:BIANCA
Middle Name:JUSELLE
Last Name:SWEETEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 UNION AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3627
Mailing Address - Country:US
Mailing Address - Phone:901-844-1459
Mailing Address - Fax:901-274-3475
Practice Address - Street 1:1407 UNION AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3627
Practice Address - Country:US
Practice Address - Phone:901-844-1459
Practice Address - Fax:901-274-3475
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34353208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1523554Medicaid
TN3857960Medicaid
H26780Medicare UPIN