Provider Demographics
NPI:1518962778
Name:BRAHENY, SHERRY LEE (MD)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:LEE
Last Name:BRAHENY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8851 CENTER DR
Mailing Address - Street 2:STE 600
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3061
Mailing Address - Country:US
Mailing Address - Phone:619-589-6106
Mailing Address - Fax:619-589-0785
Practice Address - Street 1:8851 CENTER DR
Practice Address - Street 2:STE 600
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3061
Practice Address - Country:US
Practice Address - Phone:619-589-6106
Practice Address - Fax:619-589-0785
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2011-11-22
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
CAA302152084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A3021527Medicaid
CA00A3021527Medicaid
A30215Medicare ID - Type Unspecified