Provider Demographics
NPI:1265240659
Name:WHITE, SHURONDA P
Entity type:Individual
Prefix:
First Name:SHURONDA
Middle Name:P
Last Name:WHITE
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 1:110 EWING ST UNIT 9
Mailing Address - Street 2:
Mailing Address - City:FERRIS
Mailing Address - State:TX
Mailing Address - Zip Code:75125-1904
Mailing Address - Country:US
Mailing Address - Phone:903-284-8323
Mailing Address - Fax:
Practice Address - Street 1:110 EWING ST UNIT 9
Practice Address - Street 2:
Practice Address - City:FERRIS
Practice Address - State:TX
Practice Address - Zip Code:75125-1904
Practice Address - Country:US
Practice Address - Phone:903-284-8323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14179172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker