Provider Demographics
NPI:1316600208
Name:LINZY, SHERIEKA A
Entity Type:Individual
Prefix:
First Name:SHERIEKA
Middle Name:A
Last Name:LINZY
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 1:449 SIDNEY AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-3153
Mailing Address - Country:US
Mailing Address - Phone:630-440-6276
Mailing Address - Fax:
Practice Address - Street 1:449 SIDNEY AVE UNIT B
Practice Address - Street 2:
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139-3153
Practice Address - Country:US
Practice Address - Phone:630-440-6276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL52078180842OtherDRIVER'S LICENSE