Provider Demographics
NPI:1154970754
Name:CRYER, DELDRICK SHAROD
Entity type:Individual
Prefix:
First Name:DELDRICK
Middle Name:SHAROD
Last Name:CRYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 ROOKS DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-1033
Mailing Address - Country:US
Mailing Address - Phone:985-768-7944
Mailing Address - Fax:
Practice Address - Street 1:103 ROOKS DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-1033
Practice Address - Country:US
Practice Address - Phone:985-768-7944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty