Provider Demographics
NPI:1114407731
Name:SHERMAN, SHELLEY MARIE (RN CNS)
Entity Type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:MARIE
Last Name:SHERMAN
Suffix:
Gender:F
Credentials:RN CNS
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:
Other - Last Name:PINKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5348 WARING RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-1253
Mailing Address - Country:US
Mailing Address - Phone:815-276-9381
Mailing Address - Fax:
Practice Address - Street 1:3020 CHILDRENS WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4223
Practice Address - Country:US
Practice Address - Phone:858-769-9284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA769774163W00000X
174H00000X
CA4552364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty