Provider Demographics
NPI:1821717216
Name:MARTIN, SHERMIKA DACHELL
Entity Type:Individual
Prefix:
First Name:SHERMIKA
Middle Name:DACHELL
Last Name:MARTIN
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 1:2518 LANCE LN
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-6114
Mailing Address - Country:US
Mailing Address - Phone:346-240-7386
Mailing Address - Fax:
Practice Address - Street 1:2518 LANCE LN
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-6114
Practice Address - Country:US
Practice Address - Phone:346-240-7386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor