Provider Demographics
NPI:1275976326
Name:DANDRIDGE, SHEREE L (PROSTHESIST)
Entity Type:Individual
Prefix:MRS
First Name:SHEREE
Middle Name:L
Last Name:DANDRIDGE
Suffix:
Gender:F
Credentials:PROSTHESIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-2720
Mailing Address - Country:US
Mailing Address - Phone:276-634-0200
Mailing Address - Fax:276-634-0200
Practice Address - Street 1:538 S MEMORIAL BLVD.
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112
Practice Address - Country:US
Practice Address - Phone:276-340-1833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA421718670224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist