Healthcare Provider Details

I. General information

NPI: 1629216999
Provider Name (Legal Business Name): BRENDAN JAMES SHERRY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2009
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8825 SAND TREE DR SE
ALTO MI
49302-9047
US

IV. Provider business mailing address

8825 SAND TREE DR SE
ALTO MI
49302-9047
US

V. Phone/Fax

Practice location:
  • Phone: 517-712-8296
  • Fax:
Mailing address:
  • Phone: 517-712-8296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601004552
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: