Healthcare Provider Details

I. General information

NPI: 1679678189
Provider Name (Legal Business Name): MARY T. SHERIFF, DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 ELYSIAN FIELDS AVE
NEW ORLEANS LA
70122-3875
US

IV. Provider business mailing address

43162 PECAN RIDGE DR
HAMMOND LA
70403-0602
US

V. Phone/Fax

Practice location:
  • Phone: 504-283-6754
  • Fax: 504-283-9949
Mailing address:
  • Phone: 985-902-7785
  • Fax: 985-902-7780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPD318R
License Number StateLA

VIII. Authorized Official

Name: MARY THERESA SHERIFF
Title or Position: PODIATRIST
Credential: DPM
Phone: 504-283-6754