Provider Demographics
NPI:1215593694
Name:SISTRUNK, SHIRLEY J
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:J
Last Name:SISTRUNK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:J
Other - Last Name:SISTRUNK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SENIOR LOVING CARE
Mailing Address - Street 1:PO BOX 21087
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-0087
Mailing Address - Country:US
Mailing Address - Phone:216-233-7727
Mailing Address - Fax:
Practice Address - Street 1:17325 EUCLID AVE STE 2049A
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-1247
Practice Address - Country:US
Practice Address - Phone:216-303-1415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-11
Last Update Date:2019-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care