Provider Demographics
NPI:1275240798
Name:SORRELS, SHENICIA
Entity Type:Individual
Prefix:
First Name:SHENICIA
Middle Name:
Last Name:SORRELS
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 1:3530 MANOR DR STE 6A
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-5625
Mailing Address - Country:US
Mailing Address - Phone:601-618-6149
Mailing Address - Fax:
Practice Address - Street 1:3530 MANOR DR STE 6A
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-5625
Practice Address - Country:US
Practice Address - Phone:601-618-6149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory