Provider Demographics
NPI:1336701168
Name:ROBERTS, SHEDRICK SHERMANIC
Entity Type:Individual
Prefix:
First Name:SHEDRICK
Middle Name:SHERMANIC
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SANDY LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3191
Mailing Address - Country:US
Mailing Address - Phone:757-718-1302
Mailing Address - Fax:
Practice Address - Street 1:103 SANDY LAKE DR
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3191
Practice Address - Country:US
Practice Address - Phone:757-718-1302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)