Provider Demographics
NPI:1073221958
Name:SHERROD, SHAREKA
Entity Type:Individual
Prefix:
First Name:SHAREKA
Middle Name:
Last Name:SHERROD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 E APACHE BLVD APT C2098
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-6011
Mailing Address - Country:US
Mailing Address - Phone:240-397-0554
Mailing Address - Fax:
Practice Address - Street 1:10000 N 31ST AVE STE C307
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-9569
Practice Address - Country:US
Practice Address - Phone:240-397-0554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician