Provider Demographics
NPI:1245926161
Name:KING, SEBRINA DENISE
Entity type:Individual
Prefix:
First Name:SEBRINA
Middle Name:DENISE
Last Name:KING
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 1:8395 BIDDULPH RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:OH
Mailing Address - Zip Code:44144-3215
Mailing Address - Country:US
Mailing Address - Phone:216-857-5197
Mailing Address - Fax:
Practice Address - Street 1:8395 BIDDULPH RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:OH
Practice Address - Zip Code:44144-3215
Practice Address - Country:US
Practice Address - Phone:216-857-5197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company