Healthcare Provider Details

I. General information

NPI: 1487784971
Provider Name (Legal Business Name): MISS SHEA LEIGH NERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 8TH ST
CLARKSVILLE TN
37040-3093
US

IV. Provider business mailing address

511 8TH ST
CLARKSVILLE TN
37040-3093
US

V. Phone/Fax

Practice location:
  • Phone: 931-920-7241
  • Fax: 931-920-7205
Mailing address:
  • Phone: 931-920-7241
  • Fax: 931-920-7205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0000000000
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: