Provider Demographics
NPI:1497473292
Name:SHERWOOD, ANDREA TIFFANY
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:TIFFANY
Last Name:SHERWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 GREEN POND CIR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29527-5142
Mailing Address - Country:US
Mailing Address - Phone:609-731-2428
Mailing Address - Fax:
Practice Address - Street 1:2929 GREEN POND CIR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29527-5142
Practice Address - Country:US
Practice Address - Phone:813-763-5469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty