Provider Demographics
NPI:1538125315
Name:VIDUYA, SHERRY JANE FAMORCA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:JANE FAMORCA
Last Name:VIDUYA
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:PO BOX 13955
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29422-3955
Mailing Address - Country:US
Mailing Address - Phone:843-779-6444
Mailing Address - Fax:843-779-6438
Practice Address - Street 1:110 SPRINGHALL DR STE A
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-5335
Practice Address - Country:US
Practice Address - Phone:843-973-8503
Practice Address - Fax:843-990-5068
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19583207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC195835Medicaid
SCAA57037126Medicare PIN
SCG901117498Medicare PIN
SCAA5703A634Medicare PIN
SC080186652Medicare PIN
SCG90111Medicare UPIN
SCG901115282Medicare PIN