MEDICARE: SHERRY HAYWOOD

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R120652	MD

General Provider Information

NPI Number	:	1992452387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRY HAYWOOD

Provider Business Mailing Address
First Line	:	248 GLENDA CT
Second Line	:
City	:	MILLERSVILLE
State	:	MD
Zip	:	21108-1024
Country	:	US
Telephone Number	:	410-206-1291
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 YORK RD
Second Line	:
City	:	LUTHERVILLE
State	:	MD
Zip	:	21093-6035
Country	:	US
Telephone Number	:	443-442-4818
Fax Number	:	410-650-9053

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

Provider Enumeration Date	:	03/04/2022
Last Update Date	:	03/04/2022

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