Provider Demographics
NPI:1225295470
Name:SHERWOOD, ROBERT WAYNE (ST/SA-C)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:WAYNE
Last Name:SHERWOOD
Suffix:
Gender:M
Credentials:ST/SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 271071
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-5019
Mailing Address - Country:US
Mailing Address - Phone:720-639-4188
Mailing Address - Fax:720-639-4188
Practice Address - Street 1:566 S MCCASLIN BLVD
Practice Address - Street 2:SUITE 271071
Practice Address - City:SUPERIOR
Practice Address - State:CO
Practice Address - Zip Code:80027
Practice Address - Country:US
Practice Address - Phone:720-639-4188
Practice Address - Fax:720-302-1881
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZC0007X, 363AS0400X
CO07-330246ZC0007X
COSA.0001795246ZC0007X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant