Aquanita Sheretta Ellis

Primary specialty

Home Health AideTaxonomy code 374U00000X

Practice address

808 20TH St
Phenix City, AL 36867-4525

Phone

(706) 302-9291

NPI assigned

Jul 1, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1719792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720656000000",
    "number": "1104661107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1007 SAMFORD CT APT B",
            "city": "OPELIKA",
            "state": "AL",
            "postal_code": "368019782",
            "telephone_number": "706-302-9291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 20TH ST",
            "city": "PHENIX CITY",
            "state": "AL",
            "postal_code": "368674525",
            "telephone_number": "706-302-9291"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1414 2nd St S",
            "address_purpose": "LOCATION",
            "city": "Phenix City",
            "state": "AL",
            "postal_code": "368697318",
            "country_code": "US",
            "telephone_number": "706-984-4571",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "AQUANITA",
        "middle_name": "SHERETTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-07-01",
        "last_updated": "2024-07-11",
        "certification_date": "2024-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3747A0650X",
            "taxonomy_group": "",
            "desc": "Technician, Attendant Care Provider",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "374U00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Home Health Aide",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Daryl Ellis, MD
• Miles Wayne Ellis, MD
• Emergency Staffing Solutions Inc
• Encore Rehabilitation, Inc.
• Eye Lab Vision Center, Inc.

• Home Health Aide in Phenix City, AL
• Providers in Phenix City, AL by specialty
• Home Health Aide in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.