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NPI Code Detail

MEDICARE: SHURIKA LYDEL PERRY PA

MEDICARE:   SHURIKA LYDEL PERRY  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
1363AM0700XMedical Physician Assistant10001424AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000779072OTHERINANTHEM

General Provider Information

NPI Number : 1174888135
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHURIKA LYDEL PERRY PA
Provider Business Mailing Address
First Line : 1533 CHESTER BLVD
Second Line :
City : RICHMOND
State : IN
Zip : 47374-1914
Country : US
Telephone Number : 317-319-2514
Fax Number :
Provider Business Practice Location Address
First Line : 1533 CHESTER BLVD
Second Line :
City : RICHMOND
State : IN
Zip : 47374-1914
Country : US
Telephone Number : 317-319-2514
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2012
Last Update Date : 02/18/2015

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Directions to “ SHURIKA LYDEL PERRY PA” Practice Location

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