Healthcare Provider Details

I. General information

NPI: 1093507626
Provider Name (Legal Business Name): PROF. SHEREE DANETTE MARTIN X
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2889 TUPPENCE DR
COLUMBUS OH
43232-5504
US

IV. Provider business mailing address

2889 TUPPENCE DR
COLUMBUS OH
43232-5504
US

V. Phone/Fax

Practice location:
  • Phone: 614-207-6149
  • Fax:
Mailing address:
  • Phone: 614-207-6149
  • Fax: 614-207-6149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: