Provider Demographics
NPI:1275213316
Name:MEALMAN, SHERI MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:SHERI
Middle Name:MICHELLE
Last Name:MEALMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12909 COUNTY ROAD 5 APT 304
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-2240
Mailing Address - Country:US
Mailing Address - Phone:305-200-7599
Mailing Address - Fax:
Practice Address - Street 1:1905 WAYZATA BLVD
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-5001
Practice Address - Country:US
Practice Address - Phone:952-222-8149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN14567363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical