Healthcare Provider Details

I. General information

NPI: 1972396885
Provider Name (Legal Business Name): SHERANDA LETIEESE STOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2025
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 PINETREE WAY EAST APT E
GREENWOOD IN
46143
US

IV. Provider business mailing address

1629 PINETREE WAY EAST APT E
GREENWOOD IN
46143
US

V. Phone/Fax

Practice location:
  • Phone: 463-279-0310
  • Fax:
Mailing address:
  • Phone: 463-279-0310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: