Healthcare Provider Details

I. General information

NPI: 1063714418
Provider Name (Legal Business Name): SHERRI MADRID ANDERSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13695 US HIGHWAY 1
SEBASTIAN FL
32958
US

IV. Provider business mailing address

4539 CHASTAIN DRIVE
MELBOURNE FL
32940
US

V. Phone/Fax

Practice location:
  • Phone: 772-581-2045
  • Fax:
Mailing address:
  • Phone: 321-242-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: