Provider Demographics
NPI:1649906678
Name:FUNN, SHERRI LORRAINE
Entity type:Individual
Prefix:
First Name:SHERRI
Middle Name:LORRAINE
Last Name:FUNN
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 1:375 MARKET ST APT 105
Mailing Address - Street 2:
Mailing Address - City:MANASSAS PARK
Mailing Address - State:VA
Mailing Address - Zip Code:20111-3203
Mailing Address - Country:US
Mailing Address - Phone:703-501-7619
Mailing Address - Fax:
Practice Address - Street 1:375 MARKET ST APT 105
Practice Address - Street 2:
Practice Address - City:MANASSAS PARK
Practice Address - State:VA
Practice Address - Zip Code:20111-3203
Practice Address - Country:US
Practice Address - Phone:703-501-7619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-01
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019005389225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist