Provider Demographics
NPI:1538052154
Name:EDMONSON, SHERYLENE ELIZABETH
Entity type:Individual
Prefix:
First Name:SHERYLENE
Middle Name:ELIZABETH
Last Name:EDMONSON
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 1:1212 21ST ST SW
Mailing Address - Street 2:
Mailing Address - City:LANETT
Mailing Address - State:AL
Mailing Address - Zip Code:36863-4660
Mailing Address - Country:US
Mailing Address - Phone:706-518-5390
Mailing Address - Fax:
Practice Address - Street 1:1212 21ST ST SW
Practice Address - Street 2:
Practice Address - City:LANETT
Practice Address - State:AL
Practice Address - Zip Code:36863-4660
Practice Address - Country:US
Practice Address - Phone:706-518-5390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL615821744P3200X, 335E00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No335E00000XSuppliersProsthetic/Orthotic Supplier