Individual
MRS. SHERALLA SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
402 CELTIC DR # 3101, MADISON, AL 35758-1876
(256) 867-1000
(256) 430-9830
Mailing address
402 CELTIC DR # 3101, MADISON, AL 35758-1876
(256) 867-1000
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
47B0M77
AL
343900000X
Non-emergency Medical Transport (VAN)
47B0M78
AL
343900000X
Non-emergency Medical Transport (VAN)
Primary
47B6R84
AL
343900000X
Non-emergency Medical Transport (VAN)
47D3P21
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
825424375
ATNA, HUMANNA, MEDICAID
AL
05
—
825424375
—
AL
Enumeration date
11/30/2020
Last updated
11/30/2020
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