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General NPI Number Information
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NPI Number | 1750979746
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Entity Type | Individual
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Provider Name | SPERLISHA VICTORIA AYENI
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Gender | Female
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Dates
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Enumeration Date | 01/05/2021
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Last Update Date | 01/05/2021
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Provider Practice Location Address
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Address Line | 401 N MILES ST # B101
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-1834
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Country | US
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Telephone | 270-572-4132
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Fax |
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Provider Business Mailing Address
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Address Line | 5360 SONORA RD
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City | HODGENVILLE
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State | KY
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Zip | 42748-9663
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Country | US
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Telephone | 270-363-8394
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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