Provider Demographics
NPI:1093317158
Name:KENNEDY, SHERRI
Entity Type:Individual
Prefix:MRS
First Name:SHERRI
Middle Name:
Last Name:KENNEDY
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 1:1077 NORTH CT
Mailing Address - Street 2:
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-6707
Mailing Address - Country:US
Mailing Address - Phone:330-703-2024
Mailing Address - Fax:
Practice Address - Street 1:1077 NORTH CT
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-6707
Practice Address - Country:US
Practice Address - Phone:330-703-2024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7709439Medicaid