Provider Demographics
NPI:1215772934
Name:SITHOLE, GERALD
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:
Last Name:SITHOLE
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 1:2550 W RED BIRD LN STE 201
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-2390
Mailing Address - Country:US
Mailing Address - Phone:972-800-3702
Mailing Address - Fax:
Practice Address - Street 1:2550 W RED BIRD LN STE 201
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-2390
Practice Address - Country:US
Practice Address - Phone:972-800-3702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant