Provider Demographics
NPI:1346047651
Name:BERRY, SHREE ANTIONETTE
Entity type:Individual
Prefix:MRS
First Name:SHREE
Middle Name:ANTIONETTE
Last Name:BERRY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7238 GARDEN WOOD CT
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-6595
Mailing Address - Country:US
Mailing Address - Phone:567-207-1872
Mailing Address - Fax:
Practice Address - Street 1:7238 GARDEN WOOD CT
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-6595
Practice Address - Country:US
Practice Address - Phone:567-207-1872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-142563363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily