MEDICARE: TIFFANY R SHERRED NCSP

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	174400000X	Specialist

General Provider Information

NPI Number	:	1235563776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY R SHERRED NCSP

Provider Business Mailing Address
First Line	:	100 SIMPSON DR
Second Line	:
City	:	JEFFERSON HILLS
State	:	PA
Zip	:	15025-3818
Country	:	US
Telephone Number	:	724-469-3311
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 SIMPSON DR
Second Line	:
City	:	JEFFERSON HILLS
State	:	PA
Zip	:	15025-3818
Country	:	US
Telephone Number	:	724-469-3311
Fax Number	:

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

Provider Enumeration Date	:	09/01/2013
Last Update Date	:	09/01/2013

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