Provider Demographics
NPI:1477572840
Name:SHERBONDY, DAVID SHANE (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:SHANE
Last Name:SHERBONDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 LOVETT DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-6510
Mailing Address - Country:US
Mailing Address - Phone:864-987-9747
Mailing Address - Fax:864-987-9770
Practice Address - Street 1:112 LOVETT DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6510
Practice Address - Country:US
Practice Address - Phone:864-987-9747
Practice Address - Fax:864-987-9770
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC197492084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry