Provider Demographics
NPI:1871166124
Name:MARY SHEIRBURN LLC
Entity type:Organization
Organization Name:MARY SHEIRBURN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEIRBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-453-1679
Mailing Address - Street 1:260 WILLIAMSON BLVD UNIT 730372
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8257
Mailing Address - Country:US
Mailing Address - Phone:386-453-1679
Mailing Address - Fax:386-200-5848
Practice Address - Street 1:260 WILLIAMSON BLVD UNIT 730372
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8257
Practice Address - Country:US
Practice Address - Phone:386-453-1679
Practice Address - Fax:386-200-5848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-22
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency