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NPI Code Detail

MEDICARE: SHERRY J SECREST PA

MEDICARE: SHERRY J SECREST PA
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
1363A00000XPhysician Assistant0010-00749NC
2363A00000XPhysician Assistant0110002601VA

General Provider Information

NPI Number : 1588879142
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHERRY J SECREST PA
Provider Business Mailing Address
First Line : PO BOX 9007
Second Line :
City : CHARLOTTESVILLE
State : VA
Zip : 22906-9007
Country : US
Telephone Number : 434-295-1000
Fax Number : 434-972-4266
Provider Business Practice Location Address
First Line : 1015 SPRING CREEK PKWY
Second Line :
City : ZION CROSSROADS
State : VA
Zip : 22942-7019
Country : US
Telephone Number : 434-243-9466
Fax Number : 434-243-9499
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2007
Last Update Date : 10/07/2020

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