Provider Demographics
NPI:1639416506
Name:VINCENT, SHERYL MONIQUE
Entity Type:Individual
Prefix:MISS
First Name:SHERYL
Middle Name:MONIQUE
Last Name:VINCENT
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 1:12330 WOODSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108-2419
Mailing Address - Country:US
Mailing Address - Phone:216-313-2700
Mailing Address - Fax:
Practice Address - Street 1:12330 WOODSIDE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-2419
Practice Address - Country:US
Practice Address - Phone:216-313-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400475460405376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide