MEDICARE: MS. SHERI L STOOTS

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	231H00000X	Audiologist	2201000401	VA

General Provider Information

NPI Number	:	1174722359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHERI L STOOTS

Provider Business Mailing Address
First Line	:	4828 MARKET SQUARE LN
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23112-4826
Country	:	US
Telephone Number	:	804-666-0803
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 PARK WEST CIR STE 200
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23114-5552
Country	:	US
Telephone Number	:	804-378-7443
Fax Number	:	804-378-0744

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

Provider Enumeration Date	:	07/17/2007
Last Update Date	:	05/12/2020

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