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NPI Code Detail

MEDICARE: SHAREKA SHERROD

MEDICARE:   SHAREKA  SHERROD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician
2101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1073221958
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAREKA SHERROD
Provider Business Mailing Address
First Line : 1831 E APACHE BLVD APT C2098
Second Line :
City : TEMPE
State : AZ
Zip : 85281-6011
Country : US
Telephone Number : 240-397-0554
Fax Number :
Provider Business Practice Location Address
First Line : 10000 N 31ST AVE STE C307
Second Line :
City : PHOENIX
State : AZ
Zip : 85051-9569
Country : US
Telephone Number : 240-397-0554
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2022
Last Update Date : 11/09/2022

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Directions to “ SHAREKA SHERROD ” Practice Location

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