Provider Demographics
NPI:1568153609
Name:SHERMAN, JUSTIN (MSA, CSA, LSA)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:
Last Name:SHERMAN
Suffix:
Gender:M
Credentials:MSA, CSA, LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8250 GEORGIA AVE APT 1403
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-5075
Mailing Address - Country:US
Mailing Address - Phone:757-927-6987
Mailing Address - Fax:
Practice Address - Street 1:903 HILLSIDE LAKE TER APT 605
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-5242
Practice Address - Country:US
Practice Address - Phone:443-910-0033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0136000672246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty