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NPI Code Detail

MEDICARE: DR. SHERILYN CHANTAL WHEATON M.D.

MEDICARE: DR. SHERILYN CHANTAL WHEATON M.D.
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
1207Q00000XFamily Medicine Physician229681MA
2207Q00000XFamily Medicine PhysicianA89819CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
177-0368541OTHERCATAX ID

General Provider Information

NPI Number : 1205861234
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHERILYN CHANTAL WHEATON M.D.
Provider Business Mailing Address
First Line : 2772 JOHNSON DR STE 200
Second Line :
City : VENTURA
State : CA
Zip : 93003-7262
Country : US
Telephone Number : 805-642-1430
Fax Number : 805-642-1436
Provider Business Practice Location Address
First Line : 10885 TELEGRAPH RD
Second Line :
City : VENTURA
State : CA
Zip : 93004-1272
Country : US
Telephone Number : 805-642-1430
Fax Number : 805-642-1436
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2006
Last Update Date : 01/13/2014

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