Provider Demographics
NPI:1285133710
Name:PURIFOY, SHARONDA D
Entity type:Individual
Prefix:
First Name:SHARONDA
Middle Name:D
Last Name:PURIFOY
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 1:4615 ANVERS BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-7003
Mailing Address - Country:US
Mailing Address - Phone:904-415-0342
Mailing Address - Fax:
Practice Address - Street 1:4615 ANVERS BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-7003
Practice Address - Country:US
Practice Address - Phone:904-415-0342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-10
Last Update Date:2018-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker