Provider Demographics
NPI:1124003538
Name:STENEHJEM, SHERRY HICKS (DPM)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:HICKS
Last Name:STENEHJEM
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:L
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9 SUMMER STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-1914
Mailing Address - Country:US
Mailing Address - Phone:508-528-2525
Mailing Address - Fax:508-520-8901
Practice Address - Street 1:9 SUMMER STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038
Practice Address - Country:US
Practice Address - Phone:508-528-2525
Practice Address - Fax:508-520-8901
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2192213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA27-00887OtherEVERCARE
MAY71112OtherBC/BS MA
MAAA14520OtherHARVARD PILGRIM
MA467403OtherTUFTS
MAY71112OtherBC/BS MA
Y75120Medicare ID - Type Unspecified