Provider Demographics
NPI:1083121776
Name:DE SA, SHERYL MARIA SAVITA
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:MARIA SAVITA
Last Name:DE SA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1440
Mailing Address - Country:US
Mailing Address - Phone:814-781-6758
Mailing Address - Fax:814-834-1038
Practice Address - Street 1:1100 MILLION DOLLAR HWY
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-2728
Practice Address - Country:US
Practice Address - Phone:814-781-6758
Practice Address - Fax:814-834-1038
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-04
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD471281207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty