1871901611 NPI number — MRS. SHERIDAN LASHELL WILLIAMS-PELT ASSOCIATE DEGREE

Table of content: MRS. SHERIDAN LASHELL WILLIAMS-PELT ASSOCIATE DEGREE (NPI 1871901611)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871901611 NPI number — MRS. SHERIDAN LASHELL WILLIAMS-PELT ASSOCIATE DEGREE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS-PELT
Provider First Name:
SHERIDAN
Provider Middle Name:
LASHELL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ASSOCIATE DEGREE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871901611
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 312087
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-993-4700
Provider Business Mailing Address Fax Number:
313-831-2299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19211 ANGLIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-263-0077
Provider Business Practice Location Address Fax Number:
313-305-5007
Provider Enumeration Date:
07/24/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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