Provider Demographics
NPI:1063041440
Name:WALDRON, SHERVONNE CHERISE (MBBS)
Entity Type:Individual
Prefix:DR
First Name:SHERVONNE
Middle Name:CHERISE
Last Name:WALDRON
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2041 GEORGIA AVENUE
Mailing Address - Street 2:5C-26
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20060
Mailing Address - Country:US
Mailing Address - Phone:202-865-6100
Mailing Address - Fax:
Practice Address - Street 1:2041 GEORGIA AVENUE
Practice Address - Street 2:5C-26
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060
Practice Address - Country:US
Practice Address - Phone:202-865-1924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2021-09-17
Deactivation Date:2021-04-12
Deactivation Code:
Reactivation Date:2021-09-14
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program