Healthcare Provider Details

I. General information

NPI: 1720184518
Provider Name (Legal Business Name): KENNETH D SHERRY PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 OSTRUM ST
BETHLEHEM PA
18015-1000
US

IV. Provider business mailing address

105 CEDAR CREST CT
ORWIGSBURG PA
17961-2344
US

V. Phone/Fax

Practice location:
  • Phone: 484-658-5758
  • Fax: 833-213-6428
Mailing address:
  • Phone: 570-366-1932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA000093L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA000951L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: