Provider Demographics
NPI:1386040897
Name:ABDUL, STERELLA (JD)
Entity Type:Individual
Prefix:MRS
First Name:STERELLA
Middle Name:
Last Name:ABDUL
Suffix:
Gender:F
Credentials:JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3973 LUBEC AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-5131
Mailing Address - Country:US
Mailing Address - Phone:813-368-2742
Mailing Address - Fax:
Practice Address - Street 1:3973 LUBEC AVE
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-5131
Practice Address - Country:US
Practice Address - Phone:813-368-2742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12508310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility