Provider Demographics
NPI:1164706727
Name:NEELY, SHERYL M
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:M
Last Name:NEELY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:
Other - Last Name:NEELY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:581 THREE DEGREE RD
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16002-7645
Mailing Address - Country:US
Mailing Address - Phone:724-586-7802
Mailing Address - Fax:
Practice Address - Street 1:581 THREE DEGREE RD
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16002-7645
Practice Address - Country:US
Practice Address - Phone:724-586-7802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP006596B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily