Healthcare Provider Details

I. General information

NPI: 1578532115
Provider Name (Legal Business Name): CHERYL EVANS SHEDD CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 10/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3931 MUNDY MILL ROAD
OAKWOOD GA
30566-3431
US

IV. Provider business mailing address

601 S. ENOTA DRIVE SUITE Q
GAINESVILLE GA
30501-2400
US

V. Phone/Fax

Practice location:
  • Phone: 770-503-1481
  • Fax: 770-503-1520
Mailing address:
  • Phone: 770-219-8420
  • Fax: 770-219-8440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN037691
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: