=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982261624
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAYNE SHERRELL MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2019
-----------------------------------------------------
Last Update Date | 10/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2844 LIVERNOIS RD UNIT 1259
-----------------------------------------------------
City | TROY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48099-7749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-416-1211
-----------------------------------------------------
Fax | 248-416-1211
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2844 LIVERNOIS RD UNIT 1259
-----------------------------------------------------
City | TROY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48099-7749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-416-1211
-----------------------------------------------------
Fax | 248-416-1211
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 4301510712
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------