MEDICARE: MRS. SHERIAL KNIGHTS

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	171W00000X	Contractor	CHS 1207-2604-98	FL

General Provider Information

NPI Number	:	1609040708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHERIAL KNIGHTS

Provider Business Mailing Address
First Line	:	17650 NW 40TH AVE
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-3864
Country	:	US
Telephone Number	:	305-620-4523
Fax Number	:

Provider Business Practice Location Address
First Line	:	17650 NW 40TH AVE
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-3864
Country	:	US
Telephone Number	:	305-620-4523
Fax Number	:

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

Provider Enumeration Date	:	04/18/2008
Last Update Date	:	04/18/2008

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