Provider Demographics
NPI:1679321897
Name:TERRELL, SHARAYE (LPN)
Entity type:Individual
Prefix:
First Name:SHARAYE
Middle Name:
Last Name:TERRELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2913 PENBROOKE LN
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-0361
Mailing Address - Country:US
Mailing Address - Phone:314-706-4230
Mailing Address - Fax:
Practice Address - Street 1:500 BLUFFSTONE CIR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-2736
Practice Address - Country:US
Practice Address - Phone:636-626-2520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018037170164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse