Provider Demographics
NPI:1568884948
Name:DIBERNARDO, SHERYL A (CRNA)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:A
Last Name:DIBERNARDO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SHERYL
Other - Middle Name:A
Other - Last Name:NOLTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1 VIRGINIA AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4427
Mailing Address - Country:US
Mailing Address - Phone:401-490-0927
Mailing Address - Fax:
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:DAVOL 129
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-4933
Practice Address - Fax:401-444-5090
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-20
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN00478367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIU400136827Medicare PIN