Provider Demographics
NPI:1083284301
Name:JOHNSON, SHERRY
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:JOHNSON
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 1:850 E VA BEACH BLVD APT 307
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-3233
Mailing Address - Country:US
Mailing Address - Phone:757-785-6600
Mailing Address - Fax:757-527-2920
Practice Address - Street 1:850 E VA BEACH BLVD APT 307
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-3233
Practice Address - Country:US
Practice Address - Phone:757-785-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date: