Provider Demographics
NPI:1265814974
Name:HERRIFORD, SHARDAE
Entity Type:Individual
Prefix:
First Name:SHARDAE
Middle Name:
Last Name:HERRIFORD
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 1:3035 STATEN AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-3796
Mailing Address - Country:US
Mailing Address - Phone:313-671-8893
Mailing Address - Fax:
Practice Address - Street 1:3035 STATEN AVE APT 1
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-3796
Practice Address - Country:US
Practice Address - Phone:313-671-8893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other