Provider Demographics
NPI:1699900225
Name:BRIDGES, SHERECE L
Entity type:Individual
Prefix:
First Name:SHERECE
Middle Name:L
Last Name:BRIDGES
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 1:1630 CLAUDIA AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44307-1018
Mailing Address - Country:US
Mailing Address - Phone:330-836-0055
Mailing Address - Fax:
Practice Address - Street 1:1630 CLAUDIA AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-1018
Practice Address - Country:US
Practice Address - Phone:330-836-0055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2916974Medicaid