Provider Demographics
NPI:1841666492
Name:SELLERS, SHERONA
Entity type:Individual
Prefix:MRS
First Name:SHERONA
Middle Name:
Last Name:SELLERS
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 701646
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74170-1646
Mailing Address - Country:US
Mailing Address - Phone:918-896-3693
Mailing Address - Fax:
Practice Address - Street 1:6730 S PEORIA AVE
Practice Address - Street 2:323
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3608
Practice Address - Country:US
Practice Address - Phone:918-896-3693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator