MEDICARE: SHERRY LYNN RAABE PHDHP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	DH069520	PA
2	1223D0001X	Public Health Dentistry	PHDH000248	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013504083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRY LYNN RAABE PHDHP

Provider Business Mailing Address
First Line	:	106 CHERRY RIDGE LN
Second Line	:
City	:	WEST SUNBURY
State	:	PA
Zip	:	16061-2234
Country	:	US
Telephone Number	:	814-229-9352
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 CHERRY RIDGE LN
Second Line	:
City	:	WEST SUNBURY
State	:	PA
Zip	:	16061-2234
Country	:	US
Telephone Number	:	814-229-9352
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/24/2020
Last Update Date	:	01/08/2021

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