Healthcare Provider Details

I. General information

NPI: 1295353076
Provider Name (Legal Business Name): SHEREEN KUPHALDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 S 18TH ST
SPARKS NV
89431-5518
US

IV. Provider business mailing address

610 S 18TH ST
SPARKS NV
89431-5518
US

V. Phone/Fax

Practice location:
  • Phone: 775-409-4286
  • Fax:
Mailing address:
  • Phone: 775-409-4286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: