Healthcare Provider Details

I. General information

NPI: 1477471597
Provider Name (Legal Business Name): SHERA SISTRUNK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10390 COLOMA RD STE A
RANCHO CORDOVA CA
95670-2152
US

IV. Provider business mailing address

44927 DATE AVE APT 408
LANCASTER CA
93534-2410
US

V. Phone/Fax

Practice location:
  • Phone: 866-281-9088
  • Fax:
Mailing address:
  • Phone: 866-281-9088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: