Provider Demographics
NPI:1861991655
Name:SHERIFF, MARTREASE SHUNNEAK
Entity type:Individual
Prefix:MRS
First Name:MARTREASE
Middle Name:SHUNNEAK
Last Name:SHERIFF
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 1:13720 MADISON ST # AT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-6233
Mailing Address - Country:US
Mailing Address - Phone:786-759-7494
Mailing Address - Fax:
Practice Address - Street 1:13720 MADISON ST # AT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-6233
Practice Address - Country:US
Practice Address - Phone:786-759-7494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health