Provider Demographics
NPI:1619119930
Name:TAYLOR, SHERRY LYNN (CSA OPA)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:LYNN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CSA OPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 BEACH HAVEN DR
Mailing Address - Street 2:UNIT 203
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-1252
Mailing Address - Country:US
Mailing Address - Phone:757-718-7843
Mailing Address - Fax:
Practice Address - Street 1:2308 BEACH HAVEN DR
Practice Address - Street 2:UNIT 203
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-1252
Practice Address - Country:US
Practice Address - Phone:757-718-7843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2420OtherNSAA
VA24OtherORTHOPEDIC PHYSICIAN ASSISTANT