MEDICARE: CHERYL EVANS SHEDD CNP

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	363LF0000X	Family Nurse Practitioner	RN037691	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578532115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL EVANS SHEDD CNP

Provider Business Mailing Address
First Line	:	601 S. ENOTA DRIVE
Second Line	:	SUITE Q
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-2400
Country	:	US
Telephone Number	:	770-219-8420
Fax Number	:	770-219-8440

Provider Business Practice Location Address
First Line	:	3931 MUNDY MILL ROAD
Second Line	:
City	:	OAKWOOD
State	:	GA
Zip	:	30566-3431
Country	:	US
Telephone Number	:	770-503-1481
Fax Number	:	770-503-1520

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

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	10/15/2011

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