Healthcare Provider Details

I. General information

NPI: 1689401598
Provider Name (Legal Business Name): SHERIFAT O ANIMASHAUN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4008 BOBTAIL CT
GREENSBORO NC
27405-9808
US

IV. Provider business mailing address

4008 BOBTAIL CT
GREENSBORO NC
27405-9808
US

V. Phone/Fax

Practice location:
  • Phone: 336-210-8014
  • Fax:
Mailing address:
  • Phone: 336-210-8014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberHC7542
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: