Healthcare Provider Details

I. General information

NPI: 1053842732
Provider Name (Legal Business Name): MS. SHERAH EDWARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 04/07/2017
Certification Date:
Deactivation Date: 03/30/2017
Reactivation Date: 04/07/2017

III. Provider practice location address

8281 PINEY ORCH
BLACKLICK OH
43004-8351
US

IV. Provider business mailing address

8281 PINEY ORCH
BLACKLICK OH
43004-8351
US

V. Phone/Fax

Practice location:
  • Phone: 937-478-8518
  • Fax: 614-845-8713
Mailing address:
  • Phone: 937-478-8518
  • Fax: 614-845-8713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number0203373
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: