Provider Demographics
NPI:1386026318
Name:GRACE, SHERYL (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHERYL
Middle Name:
Last Name:GRACE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 THACKER RD
Mailing Address - Street 2:
Mailing Address - City:RURAL HALL
Mailing Address - State:NC
Mailing Address - Zip Code:27045-9629
Mailing Address - Country:US
Mailing Address - Phone:336-705-1763
Mailing Address - Fax:833-377-0517
Practice Address - Street 1:180 THACKER RD
Practice Address - Street 2:
Practice Address - City:RURAL HALL
Practice Address - State:NC
Practice Address - Zip Code:27045-9629
Practice Address - Country:US
Practice Address - Phone:336-391-6133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-26
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1497370894Medicaid