MEDICARE: SHARELL SWEETWINE CNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	AOO166955	MD

General Provider Information

NPI Number	:	1881396588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARELL SWEETWINE CNA

Provider Business Mailing Address
First Line	:	7244 CASTOR AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-1109
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7244 CASTOR AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-1109
Country	:	US
Telephone Number	:	484-704-0884
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2023
Last Update Date	:	03/20/2023

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Directions to “ SHARELL SWEETWINE CNA” Practice Location

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