Provider Demographics
NPI:1326899295
Name:JOHNSON-LEE, SHERRY (CRANIAL PROSTHETIC)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:JOHNSON-LEE
Suffix:
Gender:F
Credentials:CRANIAL PROSTHETIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37622
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27627-7622
Mailing Address - Country:US
Mailing Address - Phone:919-227-6848
Mailing Address - Fax:
Practice Address - Street 1:214 NOTTINGHAM DR STE 303
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4915
Practice Address - Country:US
Practice Address - Phone:919-227-6848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFTTXCRD1DA335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC92-3371708OtherSALON BUSINESS