Provider Demographics
NPI:1093315798
Name:HENDERSON, SHARIA (MBA)
Entity Type:Individual
Prefix:MRS
First Name:SHARIA
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 GROVER DR
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29365-9251
Mailing Address - Country:US
Mailing Address - Phone:864-504-5058
Mailing Address - Fax:
Practice Address - Street 1:680 GROVER DR
Practice Address - Street 2:
Practice Address - City:LYMAN
Practice Address - State:SC
Practice Address - Zip Code:29365-9251
Practice Address - Country:US
Practice Address - Phone:864-504-5058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
SC251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health