Provider Demographics
NPI:1043076839
Name:ROGERS, SHEDRICK B
Entity type:Individual
Prefix:
First Name:SHEDRICK
Middle Name:B
Last Name:ROGERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11968 DOVER VILLAGE DR N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32220-3733
Mailing Address - Country:US
Mailing Address - Phone:904-234-7388
Mailing Address - Fax:904-379-8122
Practice Address - Street 1:11968 DOVER VILLAGE DR N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32220-3733
Practice Address - Country:US
Practice Address - Phone:904-234-7388
Practice Address - Fax:904-379-8122
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)