Provider Demographics
NPI:1518948629
Name:GOODALL, SHERYL P (NP)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:P
Last Name:GOODALL
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Mailing Address - Street 1:830 OAK ST
Mailing Address - Street 2:SUITE 105W
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1168
Mailing Address - Country:US
Mailing Address - Phone:508-427-3668
Mailing Address - Fax:508-427-2610
Practice Address - Street 1:830 OAK ST
Practice Address - Street 2:SUITE 105W
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1168
Practice Address - Country:US
Practice Address - Phone:508-427-3668
Practice Address - Fax:508-427-2610
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA170600363LA2200X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA616882OtherTUFTS
MA0355241Medicaid
MA28308OtherHEALTHNET
MAPN0849OtherBLUE CROSS
MA28308OtherHEALTHNET
MAPN0849OtherBLUE CROSS
MANP1907Medicare PIN