Provider Demographics
NPI:1619105343
Name:COUTINHO-SLEDGE, YAMARA SHEREE (MD)
Entity Type:Individual
Prefix:DR
First Name:YAMARA
Middle Name:SHEREE
Last Name:COUTINHO-SLEDGE
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:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:300 EVERGREEN DR
Practice Address - Street 2:SUITE 160
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1059
Practice Address - Country:US
Practice Address - Phone:610-358-2410
Practice Address - Fax:610-459-9183
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD457157208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103129421Medicaid