Provider Demographics
NPI:1922581107
Name:WARD, SHERETA SHUNTA
Entity Type:Individual
Prefix:MS
First Name:SHERETA
Middle Name:SHUNTA
Last Name:WARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RITA
Other - Middle Name:SHUNTA
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RITA
Mailing Address - Street 1:2036 MERCY DR APT 102
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-5645
Mailing Address - Country:US
Mailing Address - Phone:407-666-9725
Mailing Address - Fax:
Practice Address - Street 1:2036 MERCY DR APT 102
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-5645
Practice Address - Country:US
Practice Address - Phone:407-666-9725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child