MEDICARE: SHERVONDA WATSON

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1548052574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERVONDA WATSON

Provider Business Mailing Address
First Line	:	PO BOX 10772
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45402-7772
Country	:	US
Telephone Number	:	662-645-4170
Fax Number	:

Provider Business Practice Location Address
First Line	:	4461 BASCULE BRIDGE DR APT 706
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45440-3133
Country	:	US
Telephone Number	:	662-645-4170
Fax Number	:

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

Provider Enumeration Date	:	05/17/2025
Last Update Date	:	05/17/2025

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Directions to “ SHERVONDA WATSON ” Practice Location

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