Provider Demographics
NPI:1780338608
Name:RANSOM, SHEREKA TERESHA
Entity type:Individual
Prefix:
First Name:SHEREKA
Middle Name:TERESHA
Last Name:RANSOM
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 1:515 MISSISSIPPI ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:FL
Mailing Address - Zip Code:32344-2317
Mailing Address - Country:US
Mailing Address - Phone:850-694-2775
Mailing Address - Fax:
Practice Address - Street 1:515 MISSISSIPPI ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:FL
Practice Address - Zip Code:32344-2317
Practice Address - Country:US
Practice Address - Phone:850-694-2775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services