MEDICARE: ANGELA SHERMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist
2	103T00000X	Psychologist	23689	CA

General Provider Information

NPI Number	:	1063536076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA SHERMAN

Provider Business Mailing Address
First Line	:	PO BOX 750273
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94975-0273
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8260 LONGLEAF DR
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-1322
Country	:	US
Telephone Number	:	650-248-8243
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	12/12/2023

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Directions to “ ANGELA SHERMAN ” Practice Location

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