Provider Demographics
NPI:1417544172
Name:HERRON, SHEVELTA
Entity Type:Individual
Prefix:
First Name:SHEVELTA
Middle Name:
Last Name:HERRON
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 1:336 BAVARIAN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-3100
Mailing Address - Country:US
Mailing Address - Phone:937-830-9020
Mailing Address - Fax:
Practice Address - Street 1:336 BAVARIAN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-3100
Practice Address - Country:US
Practice Address - Phone:937-830-9020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No347C00000XTransportation ServicesPrivate Vehicle