Provider Demographics
NPI:1568544914
Name:SHERLINE, NADIA K (MD)
Entity Type:Individual
Prefix:
First Name:NADIA
Middle Name:K
Last Name:SHERLINE
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 1:2880 OLD DIXWELL AVENUE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3144
Mailing Address - Country:US
Mailing Address - Phone:203-288-5624
Mailing Address - Fax:203-288-7782
Practice Address - Street 1:2880 OLD DIXWELL AVENUE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3144
Practice Address - Country:US
Practice Address - Phone:203-288-5624
Practice Address - Fax:203-288-7782
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035147207N00000X
CAG85769207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
070000373Medicare ID - Type Unspecified
D29012Medicare UPIN