Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1164079117 |
---|---|
Provider Name | Sherronda Yancey |
First Address | Henderson, NC 27536-4339 |
Second Address | Henderson, NC 27536-3524 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2019 |
Last Update Date | 24/08/2019 |