Provider Demographics
NPI:1508990599
Name:MARTINEZ, SHERRY MARIA
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:MARIA
Last Name:MARTINEZ
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 1:440 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:OH
Mailing Address - Zip Code:43515-1056
Mailing Address - Country:US
Mailing Address - Phone:419-822-9222
Mailing Address - Fax:
Practice Address - Street 1:103 PALMWOOD ST
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:OH
Practice Address - Zip Code:43515-1139
Practice Address - Country:US
Practice Address - Phone:419-822-9782
Practice Address - Fax:419-822-9782
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRF442746172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH263013527101Medicaid