Provider Demographics
NPI:1487494225
Name:WILLIS, SHARONDA LATREESE
Entity type:Individual
Prefix:
First Name:SHARONDA
Middle Name:LATREESE
Last Name:WILLIS
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 1:118 E WEBER ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-1812
Mailing Address - Country:US
Mailing Address - Phone:419-820-0549
Mailing Address - Fax:
Practice Address - Street 1:118 E WEBER ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-1812
Practice Address - Country:US
Practice Address - Phone:419-820-0549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child