Provider Demographics
NPI:1609965839
Name:SERAFINI, SHERAL B (MSPT)
Entity Type:Individual
Prefix:
First Name:SHERAL
Middle Name:B
Last Name:SERAFINI
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3880 HOOD DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHSIDE
Mailing Address - State:AL
Mailing Address - Zip Code:35907-7077
Mailing Address - Country:US
Mailing Address - Phone:256-442-0258
Mailing Address - Fax:256-549-2687
Practice Address - Street 1:922 E MEIGHAN BLVD
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1922
Practice Address - Country:US
Practice Address - Phone:256-549-2688
Practice Address - Fax:256-549-2687
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH1385174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-18624OtherBC/BS PROVIDER #