Healthcare Provider Details

I. General information

NPI: 1205691615
Provider Name (Legal Business Name): SHERRYDA BURNETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5362 BRECKENWOOD DR
MEMPHIS TN
38127-2152
US

IV. Provider business mailing address

5362 BRECKENWOOD DR
MEMPHIS TN
38127-2152
US

V. Phone/Fax

Practice location:
  • Phone: 901-220-0292
  • Fax:
Mailing address:
  • Phone: 901-220-0292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: