Provider Demographics
NPI:1497231252
Name:INGRAM, SHERELLE (MED)
Entity Type:Individual
Prefix:
First Name:SHERELLE
Middle Name:
Last Name:INGRAM
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 BURLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-3108
Mailing Address - Country:US
Mailing Address - Phone:267-226-6689
Mailing Address - Fax:
Practice Address - Street 1:1420 WALNUT ST STE 1350
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-4019
Practice Address - Country:US
Practice Address - Phone:215-664-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health