Provider Demographics
NPI:1134518442
Name:SANFORD, SHAMIRIS T (LPN)
Entity Type:Individual
Prefix:MS
First Name:SHAMIRIS
Middle Name:T
Last Name:SANFORD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14318 WESTROPP AVE
Mailing Address - Street 2:UP
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44110-1829
Mailing Address - Country:US
Mailing Address - Phone:216-312-1026
Mailing Address - Fax:
Practice Address - Street 1:14318 WESTROPP AVE
Practice Address - Street 2:UP
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44110-1829
Practice Address - Country:US
Practice Address - Phone:216-312-1026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-10
Last Update Date:2015-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.153400-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse