Healthcare Provider Details

I. General information

NPI: 1790425130
Provider Name (Legal Business Name): ROBERT SINGLETON SHERRARD JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 RIDGEMONT RD
CHARLESTON WV
25314-1136
US

IV. Provider business mailing address

930 RIDGEMONT RD
CHARLESTON WV
25314-1136
US

V. Phone/Fax

Practice location:
  • Phone: 304-346-1466
  • Fax:
Mailing address:
  • Phone: 304-346-1466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number83606
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: