Provider Demographics
NPI:1255805289
Name:FRATER, SHERON C
Entity type:Individual
Prefix:MS
First Name:SHERON
Middle Name:C
Last Name:FRATER
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 1:1041 PEMBROKE AVE NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-1310
Mailing Address - Country:US
Mailing Address - Phone:321-525-1689
Mailing Address - Fax:321-349-9307
Practice Address - Street 1:1041 PEMBROKE AVE NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-1310
Practice Address - Country:US
Practice Address - Phone:321-525-1689
Practice Address - Fax:321-349-9307
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-12
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home