Most Relevant Information
Provider Data
| NPI Number: | 1003392119 |
| Provider Name: | SHELIA DENISE BLACK |
| Entity Type: | Individual |
| Taxonomy Code: | 261QD1600X |
| Specialty: | Clinic/Center |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/12/2018 |
| Last Updated: | 07/12/2018 |
Provider Practice Location
564 CYPRESS LN APT 26D
GREENVILLE
MS
387017425
Practice Location Phone/Fax
| Phone: | 6623473616 |
| Fax: |
Provider Mailing Location
564 CYPRESS LN APT 26D
GREENVILLE
MS
387017425
Provider Mailing Phone/Fax
| Phone: | 6623473616 |
| Fax: |