=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629019724
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MONIQUE M. SHERRILL M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2006
-----------------------------------------------------
Last Update Date | 06/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1202 GAULT AVE N
-----------------------------------------------------
City | FORT PAYNE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35967-3040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-997-3434
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 906 DRIVER LN NW
-----------------------------------------------------
City | FORT PAYNE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35967-8212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-997-3434
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number | MD.33738
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD.33738
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------