Provider Demographics
NPI:1356676100
Name:AWAD, SHERINE WAKIM (PA-C)
Entity Type:Individual
Prefix:
First Name:SHERINE
Middle Name:WAKIM
Last Name:AWAD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHERINE
Other - Middle Name:MARY
Other - Last Name:WAKIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:19229 MACK AVE
Mailing Address - Street 2:SUITE 24
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2858
Mailing Address - Country:US
Mailing Address - Phone:313-884-5522
Mailing Address - Fax:313-884-6054
Practice Address - Street 1:19229 MACK AVE
Practice Address - Street 2:SUITE 24
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-2858
Practice Address - Country:US
Practice Address - Phone:313-884-5522
Practice Address - Fax:313-884-6054
Is Sole Proprietor?:No
Enumeration Date:2009-10-13
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003883363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical