Healthcare Provider Details

I. General information

NPI: 1851435135
Provider Name (Legal Business Name): SHERYL NEW MSBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11455 N MERIDIAN ST SUITE 150
CARMEL IN
46032-1624
US

IV. Provider business mailing address

11455 N MERIDIAN ST SUITE 150
CARMEL IN
46032-1624
US

V. Phone/Fax

Practice location:
  • Phone: 317-848-0001
  • Fax: 317-848-0002
Mailing address:
  • Phone: 317-848-0001
  • Fax: 317-848-0002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number10000566A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: