MEDICARE: MRS. STERELLA ABDUL J.D.

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	310400000X	Assisted Living Facility	12508	FL

General Provider Information

NPI Number	:	1386040897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STERELLA ABDUL J.D.

Provider Business Mailing Address
First Line	:	3973 LUBEC AVE
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34287-5131
Country	:	US
Telephone Number	:	813-368-2742
Fax Number	:

Provider Business Practice Location Address
First Line	:	3973 LUBEC AVE
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34287-5131
Country	:	US
Telephone Number	:	813-368-2742
Fax Number	:

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

Provider Enumeration Date	:	11/10/2014
Last Update Date	:	11/10/2014

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