Provider Demographics
NPI:1609040708
Name:KNIGHTS, SHERIAL
Entity Type:Individual
Prefix:MRS
First Name:SHERIAL
Middle Name:
Last Name:KNIGHTS
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 1:17650 NW 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-3864
Mailing Address - Country:US
Mailing Address - Phone:305-620-4523
Mailing Address - Fax:
Practice Address - Street 1:17650 NW 40TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-3864
Practice Address - Country:US
Practice Address - Phone:305-620-4523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCHS 1207-2604-98171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor