MEDICARE: MRS. SHERRI JO LILLY PA

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	363A00000X	Physician Assistant	0110004401	VA

General Provider Information

NPI Number	:	1063781029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHERRI JO LILLY PA

Provider Business Mailing Address
First Line	:	100 KNOTBREAK RD
Second Line	:
City	:	SALEM
State	:	VA
Zip	:	24153-5414
Country	:	US
Telephone Number	:	540-444-5670
Fax Number	:

Provider Business Practice Location Address
First Line	:	2726 ELECTRIC RD
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-3528
Country	:	US
Telephone Number	:	540-772-4448
Fax Number	:

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

Provider Enumeration Date	:	12/21/2011
Last Update Date	:	01/15/2026

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