Provider Demographics
NPI:1023611373
Name:SHERRAD, RICKY
Entity type:Individual
Prefix:
First Name:RICKY
Middle Name:
Last Name:SHERRAD
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 1:402 TRIPLETT ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26134
Mailing Address - Country:US
Mailing Address - Phone:740-403-5113
Mailing Address - Fax:
Practice Address - Street 1:402 TRIPLETT ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:WV
Practice Address - Zip Code:26134
Practice Address - Country:US
Practice Address - Phone:740-403-5113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant