Individual
MISS SYERRA SHARDAI JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5724 N WOODSTOCK ST, PHILADELPHIA, PA 19138-2914
(215) 554-0516
Mailing address
5724 N WOODSTOCK ST, PHILADELPHIA, PA 19138-2914
(215) 554-0516
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1039441540001
—
PA
Enumeration date
12/20/2021
Last updated
12/20/2021
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