Healthcare Provider Details

I. General information

NPI: 1518962778
Provider Name (Legal Business Name): SHERRY LEE BRAHENY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date: 03/17/2006
Reactivation Date: 03/27/2006

III. Provider practice location address

8851 CENTER DR STE 600
LA MESA CA
91942-3061
US

IV. Provider business mailing address

8851 CENTER DR STE 600
LA MESA CA
91942-3061
US

V. Phone/Fax

Practice location:
  • Phone: 619-589-6106
  • Fax: 619-589-0785
Mailing address:
  • Phone: 619-589-6106
  • Fax: 619-589-0785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA30215
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: