Provider Demographics
NPI:1811712797
Name:PERRY, SHEILA
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:PERRY
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 1:100 PEAKE ROAD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:ROEBUCK
Mailing Address - State:SC
Mailing Address - Zip Code:29376-2623
Mailing Address - Country:US
Mailing Address - Phone:864-406-6901
Mailing Address - Fax:
Practice Address - Street 1:100 PEAKE ROAD
Practice Address - Street 2:SUITE 9
Practice Address - City:ROEBUCK
Practice Address - State:SC
Practice Address - Zip Code:29376-2623
Practice Address - Country:US
Practice Address - Phone:864-406-6901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC011250111343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)