Provider Demographics
NPI:1679235139
Name:NELSON, SHERIEKA VONTAZE (NEMT)
Entity Type:Individual
Prefix:
First Name:SHERIEKA
Middle Name:VONTAZE
Last Name:NELSON
Suffix:
Gender:F
Credentials:NEMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 47024
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33646-0109
Mailing Address - Country:US
Mailing Address - Phone:813-424-7696
Mailing Address - Fax:
Practice Address - Street 1:1540 CLEARGLADES DR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-5718
Practice Address - Country:US
Practice Address - Phone:813-424-7696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver