Healthcare Provider Details

I. General information

NPI: 1831119098
Provider Name (Legal Business Name): SHERI BOOTH BEAL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 AUBURN RD
SUMMERFIELD NC
27358-9233
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 336-660-5270
  • Fax: 336-660-5289
Mailing address:
  • Phone: 336-643-5800
  • Fax: 336-643-7474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number103759
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: