Healthcare Provider Details

I. General information

NPI: 1013457381
Provider Name (Legal Business Name): LYDIA NYAKONU SHERMAN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2017
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5821 CEDAR LAKE RD S STE 201
ST LOUIS PARK MN
55416-1486
US

IV. Provider business mailing address

5821 CEDAR LAKE RD S STE 201
ST LOUIS PARK MN
55416-1486
US

V. Phone/Fax

Practice location:
  • Phone: 612-293-0352
  • Fax:
Mailing address:
  • Phone: 612-293-0352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP5041
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberCNP5041
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: