Healthcare Provider Details

I. General information

NPI: 1013034875
Provider Name (Legal Business Name): DAVID JAMES SHERDEN JR. ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5405 SE WOODWARD ST
PORTLAND OR
97206-2168
US

IV. Provider business mailing address

5265 NW SEWELL RD
HILLSBORO OR
97124-4716
US

V. Phone/Fax

Practice location:
  • Phone: 503-916-5140
  • Fax:
Mailing address:
  • Phone: 503-693-0870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT-AT-749767
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: