Provider Demographics
NPI:1124402524
Name:BLACK, SHERRIE TREDE (LAC)
Entity Type:Individual
Prefix:MS
First Name:SHERRIE
Middle Name:TREDE
Last Name:BLACK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:SHERRIE
Other - Middle Name:MARIE
Other - Last Name:TREDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1321 GENERALS HIGHWAY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CROWNSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21032
Mailing Address - Country:US
Mailing Address - Phone:410-923-0090
Mailing Address - Fax:410-923-0045
Practice Address - Street 1:10436 OWEN BROWN RD.
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044
Practice Address - Country:US
Practice Address - Phone:410-707-0168
Practice Address - Fax:410-992-5424
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU-01429171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist