Healthcare Provider Details

I. General information

NPI: 1063176923
Provider Name (Legal Business Name): GUERNISHA ULYSSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 GOLFSIDE CIR
SANFORD FL
32773-4765
US

IV. Provider business mailing address

156 GOLFSIDE CIR
SANFORD FL
32773-4765
US

V. Phone/Fax

Practice location:
  • Phone: 720-779-7164
  • Fax:
Mailing address:
  • Phone: 720-779-7164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: