Healthcare Provider Details

I. General information

NPI: 1306401450
Provider Name (Legal Business Name): CAROLINE SYDNIE SHERRILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2019
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 TALBERT AVE STE 201
FOUNTAIN VALLEY CA
92708-5153
US

IV. Provider business mailing address

9900 TALBERT AVE STE 201
FOUNTAIN VALLEY CA
92708-5153
US

V. Phone/Fax

Practice location:
  • Phone: 714-509-4600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA182077
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: