Provider Demographics
NPI:1497436117
Name:SHERMAN, SHANNE KAYANNE
Entity Type:Individual
Prefix:
First Name:SHANNE
Middle Name:KAYANNE
Last Name:SHERMAN
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 1:673 SE STARFISH AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-4660
Mailing Address - Country:US
Mailing Address - Phone:772-259-2190
Mailing Address - Fax:
Practice Address - Street 1:673 SE STARFISH AVE
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-4660
Practice Address - Country:US
Practice Address - Phone:772-259-2190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL239440376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker