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General NPI Number Information
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NPI Number | 1790257459
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Entity Type | Organization
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Legal Business Name | DR. MONIQUE M SHERRILL, LLC
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Dates
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Enumeration Date | 12/19/2018
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Last Update Date | 12/27/2018
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Provider Practice Location Address
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Address Line | 1202 GAULT AVE N
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City | FORT PAYNE
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State | AL
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Zip | 35967-3040
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Country | US
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Telephone | 256-997-3434
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Fax |
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Provider Business Mailing Address
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Address Line | 906 DRIVER LN NW
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City | FORT PAYNE
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State | AL
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Zip | 35967-8212
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Country | US
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Telephone | 256-997-3434
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATION
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Name | LISA WESTFALL
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Credential |
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Telephone | 256-997-7466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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