Healthcare Provider Details

I. General information

NPI: 1639133564
Provider Name (Legal Business Name): AUDREY MAY SHERMAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 SW BEAVERTON HILLSDALE HWY STE 500
BEAVERTON OR
97005-3037
US

IV. Provider business mailing address

1916 SW MARIGOLD ST
PORTLAND OR
97219-4150
US

V. Phone/Fax

Practice location:
  • Phone: 503-334-7019
  • Fax: 503-892-4557
Mailing address:
  • Phone: 503-334-7019
  • Fax: 503-892-4557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1490
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: