Provider Demographics
NPI:1003256389
Name:SHERRELL, SYDNEY WALLACE (NP)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:WALLACE
Last Name:SHERRELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SYDNEY
Other - Middle Name:LEA
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1600 ACCELERATOR WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-3078
Mailing Address - Country:US
Mailing Address - Phone:865-546-2663
Mailing Address - Fax:
Practice Address - Street 1:1600 ACCELERATOR WAY STE 200
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-3078
Practice Address - Country:US
Practice Address - Phone:865-546-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17707363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4745259OtherAETNA
TN4354347OtherBLUECROSS BLUESHIELD
TNQ000771Medicaid
TN1003256389OtherRR MEDICARE PIN
TN103I507759Medicare PIN
TN103I504107Medicare PIN