MEDICARE: JEREMIE J SHERMAN NP

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	363L00000X	Nurse Practitioner	1521	SC

General Provider Information

NPI Number	:	1619993409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMIE J SHERMAN NP

Provider Business Mailing Address
First Line	:	4416 FOREST DR
Second Line	:	2ND FLOOR
City	:	COLUMBIA
State	:	SC
Zip	:	29206-3104
Country	:	US
Telephone Number	:	803-782-4278
Fax Number	:	803-782-3445

Provider Business Practice Location Address
First Line	:	3240 SUNSET BLVD
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29169-3428
Country	:	US
Telephone Number	:	803-796-4251
Fax Number	:	803-796-4449

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	07/08/2007

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