Provider Demographics
NPI:1184390916
Name:FORMAN, KERRI SHEA (CST, AS)
Entity type:Individual
Prefix:MS
First Name:KERRI
Middle Name:SHEA
Last Name:FORMAN
Suffix:
Gender:F
Credentials:CST, AS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 RAINBOW RD
Mailing Address - Street 2:
Mailing Address - City:CHEPACHET
Mailing Address - State:RI
Mailing Address - Zip Code:02814-4456
Mailing Address - Country:US
Mailing Address - Phone:401-486-4878
Mailing Address - Fax:
Practice Address - Street 1:7445 W. WASHINGTON AVE
Practice Address - Street 2:302
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128
Practice Address - Country:US
Practice Address - Phone:281-742-9544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic