Healthcare Provider Details

I. General information

NPI: 1144677915
Provider Name (Legal Business Name): SHERITTA MARIE BUFORD MT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2016
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19464 LIVERNOIS AVE
DETROIT MI
48221-1760
US

IV. Provider business mailing address

3018 MANISTIQUE ST
DETROIT MI
48215-2560
US

V. Phone/Fax

Practice location:
  • Phone: 313-633-4152
  • Fax:
Mailing address:
  • Phone: 313-633-4152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501009330
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: