Provider Demographics
NPI:1871802322
Name:BRIZENDINE, SHARI LYNN
Entity type:Individual
Prefix:MS
First Name:SHARI
Middle Name:LYNN
Last Name:BRIZENDINE
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 1:3429 VALLEY VIEW AVE NW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-3921
Mailing Address - Country:US
Mailing Address - Phone:540-563-1119
Mailing Address - Fax:
Practice Address - Street 1:3429 VALLEY VIEW AVE NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-3921
Practice Address - Country:US
Practice Address - Phone:540-563-1119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000390224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant