Provider Demographics
NPI:1518312602
Name:MUNGIN, SHERMAL
Entity Type:Individual
Prefix:
First Name:SHERMAL
Middle Name:
Last Name:MUNGIN
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 1:537 FALLAW RD
Mailing Address - Street 2:
Mailing Address - City:GASTON
Mailing Address - State:SC
Mailing Address - Zip Code:29053-9749
Mailing Address - Country:US
Mailing Address - Phone:803-463-8072
Mailing Address - Fax:803-834-4762
Practice Address - Street 1:537 FALLAW RD
Practice Address - Street 2:
Practice Address - City:GASTON
Practice Address - State:SC
Practice Address - Zip Code:29053-9749
Practice Address - Country:US
Practice Address - Phone:803-463-8072
Practice Address - Fax:803-834-4762
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20165176350655374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide