Provider Demographics
NPI:1700693652
Name:CROSS, SHEILA L
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:L
Last Name:CROSS
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 1:62 GRAY AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-1094
Mailing Address - Country:US
Mailing Address - Phone:631-428-5315
Mailing Address - Fax:
Practice Address - Street 1:4420 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-1024
Practice Address - Country:US
Practice Address - Phone:313-605-1603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health