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NPI Code Detail

MEDICARE: SHERRY M MARINELLO PA

MEDICARE: SHERRY M MARINELLO 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
1363A00000XPhysician Assistant9433MN

General Provider Information

NPI Number : 1528033149
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHERRY M MARINELLO PA
Provider Business Mailing Address
First Line : 8170 33RD AVE S
Second Line : MS 21110Q
City : BLOOMINGTON
State : MN
Zip : 55425-4516
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 15245 BLUEBIRD ST NW
Second Line :
City : ANDOVER
State : MN
Zip : 55304-3538
Country : US
Telephone Number : 763-587-4600
Fax Number : 763-587-4615
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2006
Last Update Date : 08/11/2021

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Directions to “ SHERRY M MARINELLO PA” Practice Location

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