Healthcare Provider Details

I. General information

NPI: 1073221958
Provider Name (Legal Business Name): SHAREKA SHERROD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 N 31ST AVE STE C307
PHOENIX AZ
85051-9569
US

IV. Provider business mailing address

1831 E APACHE BLVD APT C2098
TEMPE AZ
85281-6011
US

V. Phone/Fax

Practice location:
  • Phone: 240-397-0554
  • Fax:
Mailing address:
  • Phone: 240-397-0554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: