Provider Demographics
NPI:1235114018
Name:NICCOLI, SHERRY L (MD)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:L
Last Name:NICCOLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 N MAIN
Mailing Address - Street 2:STE 2C
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230
Mailing Address - Country:US
Mailing Address - Phone:970-641-2885
Mailing Address - Fax:970-641-2898
Practice Address - Street 1:234 N MAIN
Practice Address - Street 2:STE 2C
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230
Practice Address - Country:US
Practice Address - Phone:970-641-2885
Practice Address - Fax:970-641-2898
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42817207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO73353213Medicaid
800647Medicare ID - Type Unspecified
CO73353213Medicaid
I23875Medicare UPIN