Provider Demographics
NPI:1548075476
Name:BROOKS, SHERONA DE'NAE
Entity type:Individual
Prefix:
First Name:SHERONA
Middle Name:DE'NAE
Last Name:BROOKS
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 1:5114 WESTERN BLVD APT 1313
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-0034
Mailing Address - Country:US
Mailing Address - Phone:310-382-0195
Mailing Address - Fax:910-238-4152
Practice Address - Street 1:5114 WESTERN BLVD APT 1313
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-0034
Practice Address - Country:US
Practice Address - Phone:103-820-1959
Practice Address - Fax:910-238-4152
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251E00000XAgenciesHome Health
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1134934805Medicaid