Provider Demographics
NPI:1871975870
Name:CARSON, SHERYL
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:
Last Name:CARSON
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 1:16915 LIVERNOIS AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-3058
Mailing Address - Country:US
Mailing Address - Phone:313-790-4032
Mailing Address - Fax:313-931-3982
Practice Address - Street 1:8222 JOY RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48204-3253
Practice Address - Country:US
Practice Address - Phone:313-283-1611
Practice Address - Fax:313-931-3982
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI251EOtherHOME HEALTH CARE AGENCY