Healthcare Provider Details

I. General information

NPI: 1629053699
Provider Name (Legal Business Name): SHERYL ANN HAGGERTY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5290 ELVAS AVE
SACRAMENTO CA
95819-2332
US

IV. Provider business mailing address

1416 TOWSE DR
WOODLAND CA
95776-6715
US

V. Phone/Fax

Practice location:
  • Phone: 916-739-1507
  • Fax: 815-361-9113
Mailing address:
  • Phone: 707-365-7640
  • Fax: 815-361-9113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA98050
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD-12052
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: