Provider Demographics
NPI:1447867379
Name:MADDOX, SHERONDA L
Entity type:Individual
Prefix:
First Name:SHERONDA
Middle Name:L
Last Name:MADDOX
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 1:19151 LOCHERIE AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44119-1409
Mailing Address - Country:US
Mailing Address - Phone:216-772-6580
Mailing Address - Fax:
Practice Address - Street 1:19151 LOCHERIE AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44119-1409
Practice Address - Country:US
Practice Address - Phone:216-772-6580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide