Individual provider Active NPI

Sherena R Valico, RN

  • Registered Nurse
  • Decatur, GA
National Provider Identifier
1376892257
Registry record updated Sep 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
RN211202 Issued in GA
Practice address
4151 Memorial Dr
Suite 209C
Decatur, GA 30032-1504
Phone
(404) 508-0078
Fax
(404) 508-0071
NPI assigned
Sep 6, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN211202 GA Primary

Addresses

Primary practice location

4151 Memorial Dr
Suite 209C
Decatur, GA 30032-1504

Mailing address

7047 Ravenwood LN
Lithonia, GA 30038-7535
Phone (860) 250-6562

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
RN211202GAMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Assertive Community Recovery, LLC PastSince Jul 19, 2017 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1346889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346889600000",
    "number": "1376892257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7047 RAVENWOOD LN",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300387535",
            "telephone_number": "860-250-6562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4151 MEMORIAL DR",
            "address_2": "SUITE 209C",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300321504",
            "telephone_number": "404-508-0078",
            "fax_number": "404-508-0071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VALICO",
        "first_name": "SHERENA",
        "middle_name": "R",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-06",
        "last_updated": "2012-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "GA",
            "license": "RN211202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2012; 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.