Provider Demographics
NPI:1053166439
Name:DISNEY, SHERILENNA KAY
Entity type:Individual
Prefix:
First Name:SHERILENNA
Middle Name:KAY
Last Name:DISNEY
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 1:6521 ASHLEY SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47111-9082
Mailing Address - Country:US
Mailing Address - Phone:606-627-5002
Mailing Address - Fax:
Practice Address - Street 1:6521 ASHLEY SPRINGS CT
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:IN
Practice Address - Zip Code:47111-9082
Practice Address - Country:US
Practice Address - Phone:606-627-5002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY200008858222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist