Healthcare Provider Details

I. General information

NPI: 1881897635
Provider Name (Legal Business Name): SHERYL A EBERT PHD, MSPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 JEFFERSON AVE MEMPHIS VAMC
MEMPHIS TN
38104-2127
US

IV. Provider business mailing address

385 NAIL RD P187
SOUTHAVEN MS
38671-8853
US

V. Phone/Fax

Practice location:
  • Phone: 901-523-8990
  • Fax:
Mailing address:
  • Phone: 662-349-7791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: