Provider Demographics
NPI:1851914568
Name:MCKENZIE, SHERLON WAINWRIGHT
Entity Type:Individual
Prefix:
First Name:SHERLON
Middle Name:WAINWRIGHT
Last Name:MCKENZIE
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 1:326 IVANHILL RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-5250
Mailing Address - Country:US
Mailing Address - Phone:567-277-3672
Mailing Address - Fax:
Practice Address - Street 1:326 IVANHILL RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-5250
Practice Address - Country:US
Practice Address - Phone:567-277-3672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-28
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH851211026OtherHOME CARE