Provider Demographics
NPI:1053842732
Name:EDWARDS, SHERAH
Entity type:Individual
Prefix:MS
First Name:SHERAH
Middle Name:
Last Name:EDWARDS
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 1:8281 PINEY ORCH
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-8351
Mailing Address - Country:US
Mailing Address - Phone:937-478-8518
Mailing Address - Fax:614-845-8713
Practice Address - Street 1:8281 PINEY ORCH
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-8351
Practice Address - Country:US
Practice Address - Phone:937-478-8518
Practice Address - Fax:614-845-8713
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-23
Last Update Date:2017-04-07
Deactivation Date:2017-03-30
Deactivation Code:
Reactivation Date:2017-04-07
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X
OH02033733747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0203373Medicaid