Provider Demographics
NPI:1518352814
Name:HERRON, T'MELIA STEPHANIE
Entity Type:Individual
Prefix:
First Name:T'MELIA
Middle Name:STEPHANIE
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 1:25535 GREENFIELD RD
Mailing Address - Street 2:APT 201
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2146
Mailing Address - Country:US
Mailing Address - Phone:586-464-7426
Mailing Address - Fax:
Practice Address - Street 1:25535 GREENFIELD RD
Practice Address - Street 2:APT 201
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2146
Practice Address - Country:US
Practice Address - Phone:586-464-7426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIH650797777341247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other