Provider Demographics
NPI:1255932208
Name:ADAMS MEHAFFEY, SHERRY
Entity type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:
Last Name:ADAMS MEHAFFEY
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:PO BOX 1263
Mailing Address - Street 2:
Mailing Address - City:LUCASVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45648-1263
Mailing Address - Country:US
Mailing Address - Phone:740-727-8307
Mailing Address - Fax:
Practice Address - Street 1:1706 SHEPHERD FORK RD
Practice Address - Street 2:
Practice Address - City:WEST PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45663-9037
Practice Address - Country:US
Practice Address - Phone:740-727-8307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0000275113Medicaid