Provider Demographics
NPI:1386905834
Name:KELLY, SHERRITA P
Entity type:Individual
Prefix:
First Name:SHERRITA
Middle Name:P
Last Name:KELLY
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 1:1507 45TH ST NE
Mailing Address - Street 2:N.E.
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-2002
Mailing Address - Country:US
Mailing Address - Phone:202-276-1997
Mailing Address - Fax:
Practice Address - Street 1:1507 45TH ST NE
Practice Address - Street 2:N.E.
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-2002
Practice Address - Country:US
Practice Address - Phone:202-276-1997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide