Healthcare Provider Details

I. General information

NPI: 1699066340
Provider Name (Legal Business Name): CHERYL SHERROD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2011
Last Update Date: 03/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 W UNIVERSITY DR 3-NORTH
ROCHESTER MI
48307-1863
US

IV. Provider business mailing address

1101 W UNIVERSITY DR 3-NORTH
ROCHESTER MI
48307-1863
US

V. Phone/Fax

Practice location:
  • Phone: 248-601-4900
  • Fax: 249-601-4994
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD.207362
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: