Provider Demographics
NPI:1366031726
Name:CLARK, SHERRI L (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:SHERRI
Middle Name:L
Last Name:CLARK
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:MRS
Other - First Name:SHERRI
Other - Middle Name:
Other - Last Name:CLEVELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1326 S GOVERNORS AVE
Mailing Address - Street 2:STE C
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-4800
Mailing Address - Country:US
Mailing Address - Phone:302-612-0352
Mailing Address - Fax:302-566-2866
Practice Address - Street 1:1326 S GOVERNORS AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-4800
Practice Address - Country:US
Practice Address - Phone:302-612-0352
Practice Address - Fax:224-353-4867
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL8-0010234363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty