Provider Demographics
NPI:1578532115
Name:SHEDD, CHERYL EVANS (CNP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:EVANS
Last Name:SHEDD
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S. ENOTA DRIVE
Mailing Address - Street 2:SUITE Q
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-2400
Mailing Address - Country:US
Mailing Address - Phone:770-219-8420
Mailing Address - Fax:770-219-8440
Practice Address - Street 1:3931 MUNDY MILL ROAD
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-3431
Practice Address - Country:US
Practice Address - Phone:770-503-1481
Practice Address - Fax:770-503-1520
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN037691363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00944897BMedicaid
GA00944897Medicaid
GA00944897BMedicaid
GA50BBFWBMedicare PIN