Provider Demographics
NPI:1275649048
Name:MA, SHERRY X (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:X
Last Name:MA
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2315 DOUGHERTY FERRY RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-3383
Mailing Address - Country:US
Mailing Address - Phone:314-984-8380
Mailing Address - Fax:314-984-5091
Practice Address - Street 1:2315 DOUGHERTY FERRY RD
Practice Address - Street 2:SUITE 207
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-3383
Practice Address - Country:US
Practice Address - Phone:314-984-8380
Practice Address - Fax:314-984-5091
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO1062972084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208715508Medicaid
MO190661OtherBLUE CROSS AND SHIELD
MO108428OtherBLUE CROSS AND SHIELD
MO0500157OtherUNITED HEALTH CARE
MO333473OtherHEALTHLINK
5868624OtherAETNA
MO218597OtherGROUP HEALTH PLAN ID
MO219697OtherGROUP HEALTH PLAN ID NUMB
MO190661OtherBLUE CROSS AND SHIELD
MOG50655Medicare UPIN