Provider Demographics
NPI:1659978484
Name:SHEEM, CEDRICK K
Entity Type:Individual
Prefix:
First Name:CEDRICK
Middle Name:K
Last Name:SHEEM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 BLUESTONE CT
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:SC
Mailing Address - Zip Code:29571-6060
Mailing Address - Country:US
Mailing Address - Phone:843-468-3993
Mailing Address - Fax:
Practice Address - Street 1:831 BLUESTONE CT
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:SC
Practice Address - Zip Code:29571-6060
Practice Address - Country:US
Practice Address - Phone:843-468-3993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11304225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist