Provider Demographics
NPI:1487170601
Name:BOOTHE, SHERI YVETTE
Entity type:Individual
Prefix:
First Name:SHERI
Middle Name:YVETTE
Last Name:BOOTHE
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 1:384 LEELAND AVE
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23661-2524
Mailing Address - Country:US
Mailing Address - Phone:757-729-7700
Mailing Address - Fax:
Practice Address - Street 1:384 LEELAND AVE
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23661-2366
Practice Address - Country:US
Practice Address - Phone:757-729-7700
Practice Address - Fax:757-729-7700
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401097259251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health