MEDICARE: SHERI A GILLIS-FUNDERBURK MD

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	25MA07706200	NJ

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	:	1922078195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERI A GILLIS-FUNDERBURK MD

Provider Business Mailing Address
First Line	:	2 CAPITAL WAY
Second Line	:	SUITE 290
City	:	PENNINGTON
State	:	NJ
Zip	:	08534-2521
Country	:	US
Telephone Number	:	609-303-4300
Fax Number	:	609-303-4301

Provider Business Practice Location Address
First Line	:	2 CAPITAL WAY
Second Line	:	SUITE 290
City	:	PENNINGTON
State	:	NJ
Zip	:	08534-2521
Country	:	US
Telephone Number	:	609-303-4300
Fax Number	:	609-303-4301

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	04/27/2021

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