Provider Demographics
NPI:1427645126
Name:READOUS, SHERENA
Entity type:Individual
Prefix:
First Name:SHERENA
Middle Name:
Last Name:READOUS
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 1:4309 TREEHILLS PKWY
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-3086
Mailing Address - Country:US
Mailing Address - Phone:734-635-2691
Mailing Address - Fax:
Practice Address - Street 1:4309 TREEHILLS PKWY
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30088-3086
Practice Address - Country:US
Practice Address - Phone:734-635-2691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC560107010211730183700000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No183700000XPharmacy Service ProvidersPharmacy Technician