MEDICARE: DR. SHERRI NIELSEN PSY.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	103TC0700X	Clinical Psychologist	PSY 26749	CA

General Provider Information

NPI Number	:	1841695129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHERRI NIELSEN PSY.D.

Provider Business Mailing Address
First Line	:	953 W 18TH ST
Second Line	:	#2
City	:	SAN PEDRO
State	:	CA
Zip	:	90731-4554
Country	:	US
Telephone Number	:	310-702-6501
Fax Number	:

Provider Business Practice Location Address
First Line	:	1539 HARBOR AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-1322
Country	:	US
Telephone Number	:	310-702-6501
Fax Number	:

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

Provider Enumeration Date	:	10/28/2014
Last Update Date	:	10/31/2014

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