MEDICARE: DR. TERRY WAYNE SHERRADEN 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
1	174400000X	Specialist	ME0045932	FL

General Provider Information

NPI Number	:	1629003207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRY WAYNE SHERRADEN M.D.

Provider Business Mailing Address
First Line	:	2633 CENTENNIAL BLVD
Second Line	:	SUITE 100
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-0585
Country	:	US
Telephone Number	:	850-877-7387
Fax Number	:	850-656-3376

Provider Business Practice Location Address
First Line	:	2406 E PLAZA DR
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-5301
Country	:	US
Telephone Number	:	850-877-7387
Fax Number	:	850-656-3376

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	02/27/2017

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