Provider Demographics
NPI:1942842976
Name:BOYD, SARHENA SERANNA
Entity Type:Individual
Prefix:MRS
First Name:SARHENA
Middle Name:SERANNA
Last Name:BOYD
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:N85W16100 APPLETON AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-3000
Mailing Address - Country:US
Mailing Address - Phone:262-804-2699
Mailing Address - Fax:
Practice Address - Street 1:N85W16100 APPLETON AVE STE 207
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-3000
Practice Address - Country:US
Practice Address - Phone:262-804-2699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14543-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI14543-146OtherANTHEM BLUE ACROSS