Provider Demographics
NPI:1073243127
Name:NALLS, SHEREKA
Entity Type:Individual
Prefix:
First Name:SHEREKA
Middle Name:
Last Name:NALLS
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 1:3928 DELPHOS AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-5217
Mailing Address - Country:US
Mailing Address - Phone:937-607-1723
Mailing Address - Fax:
Practice Address - Street 1:4130 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45432-3015
Practice Address - Country:US
Practice Address - Phone:937-716-1791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator