Provider Demographics
NPI:1952888703
Name:LIGHTFOOT, SHERAH ASHLEY (CRANIAL SPECIALIST)
Entity Type:Individual
Prefix:MRS
First Name:SHERAH
Middle Name:ASHLEY
Last Name:LIGHTFOOT
Suffix:
Gender:F
Credentials:CRANIAL SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2904 BROOKCROSSING DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-4615
Mailing Address - Country:US
Mailing Address - Phone:336-378-2832
Mailing Address - Fax:910-339-8148
Practice Address - Street 1:2904 BROOKCROSSING DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-4615
Practice Address - Country:US
Practice Address - Phone:336-378-2832
Practice Address - Fax:910-339-8148
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC1048481744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management