Provider Demographics
NPI:1568456523
Name:MORELLI, SHERYL AGRESTA (MD)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:AGRESTA
Last Name:MORELLI
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 1:6901 SAND POINT WAY NE
Mailing Address - Street 2:SPW-114
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-7869
Mailing Address - Country:US
Mailing Address - Phone:206-987-6016
Mailing Address - Fax:206-987-2516
Practice Address - Street 1:6901 SAND POINT WAY NE
Practice Address - Street 2:SPW-114
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-7869
Practice Address - Country:US
Practice Address - Phone:206-987-6016
Practice Address - Fax:206-987-2516
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35080491208000000X
WAMD00049402208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2408522Medicaid
KY64068182Medicaid
KY64068182Medicaid
H84024Medicare UPIN