Individual
SHERITA BLACKBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1505 SUMMERDALE ST, PITTSBURGH, PA 15204-1130
(412) 586-8548
Mailing address
1505 SUMMERDALE ST, PITTSBURGH, PA 15204-1130
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1026148700002
—
PA
Enumeration date
03/23/2016
Last updated
03/23/2016
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