MEDICARE: KENYETTA SHARDAE HERD LMSW

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
1	104100000X	Social Worker		AZ

General Provider Information

NPI Number	:	1194381228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENYETTA SHARDAE HERD LMSW

Provider Business Mailing Address
First Line	:	13000 N 103RD AVE STE 98
Second Line	:
City	:	SUN CITY
State	:	AZ
Zip	:	85351-3057
Country	:	US
Telephone Number	:	623-974-3333
Fax Number	:	623-974-3390

Provider Business Practice Location Address
First Line	:	13000 N 103RD AVE STE 98
Second Line	:
City	:	SUN CITY
State	:	AZ
Zip	:	85351-3057
Country	:	US
Telephone Number	:	623-974-3333
Fax Number	:	623-974-3390

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2019
Last Update Date	:	02/02/2026

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