Provider Demographics
NPI:1285307702
Name:ANDERSON, SHELARRI DIONE (CMF)
Entity type:Individual
Prefix:
First Name:SHELARRI
Middle Name:DIONE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2824 N 17TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53206-2131
Mailing Address - Country:US
Mailing Address - Phone:414-975-1366
Mailing Address - Fax:
Practice Address - Street 1:2824 N 17TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53206-2131
Practice Address - Country:US
Practice Address - Phone:414-975-1366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy FitterGroup - Multi-Specialty