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NPI Code Detail

MEDICARE: SHERISE L.E. DEARDORFF PA-C

MEDICARE: SHERISE L.E. DEARDORFF PA-C
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
1363AM0700XMedical Physician Assistant10001777AIN

General Provider Information

NPI Number : 1164738662
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHERISE L.E. DEARDORFF PA-C
Provider Business Mailing Address
First Line : 11109 PARKVIEW PLAZA DR # 117
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1701
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1655 N CASS ST
Second Line :
City : WABASH
State : IN
Zip : 46992-9416
Country : US
Telephone Number : 260-563-2126
Fax Number : 260-569-2494
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2010
Last Update Date : 10/07/2022

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