Provider Demographics
NPI:1417064627
Name:GOODWIN, SHERYL (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27000 FORESTVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-1560
Mailing Address - Country:US
Mailing Address - Phone:216-261-8460
Mailing Address - Fax:
Practice Address - Street 1:27000 FORESTVIEW AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-1560
Practice Address - Country:US
Practice Address - Phone:216-261-8460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH309363163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2560723Medicaid