Provider Demographics
NPI:1497120067
Name:FULLER, SHERATON (MHS)
Entity Type:Individual
Prefix:
First Name:SHERATON
Middle Name:
Last Name:FULLER
Suffix:
Gender:F
Credentials:MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71052-2605
Mailing Address - Country:US
Mailing Address - Phone:318-872-0262
Mailing Address - Fax:318-872-3329
Practice Address - Street 1:213 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:LA
Practice Address - Zip Code:71052-2605
Practice Address - Country:US
Practice Address - Phone:318-872-0262
Practice Address - Fax:318-872-3329
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-08
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator