Provider Demographics
NPI:1861105173
Name:MORGAN, SYREETA CHERILYN
Entity type:Individual
Prefix:
First Name:SYREETA
Middle Name:CHERILYN
Last Name:MORGAN
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 1:725 CORLEY ST
Mailing Address - Street 2:725 CORLEY ST
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44306-1274
Mailing Address - Country:US
Mailing Address - Phone:757-819-8139
Mailing Address - Fax:
Practice Address - Street 1:725 CORLEY ST
Practice Address - Street 2:725 CORLEY ST
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-1274
Practice Address - Country:US
Practice Address - Phone:757-819-8139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver