Provider Demographics
NPI:1619968187
Name:WILLIAMS, SHERYL JANINE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:SHERYL
Middle Name:JANINE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA-C
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 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5050 NE HOYT ST
Practice Address - Street 2:SUITE 454
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2991
Practice Address - Country:US
Practice Address - Phone:503-254-6405
Practice Address - Fax:503-215-6429
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00743363AM0700X
WAPA10005231363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP01178825OtherRR MEDICARE - PHS
OR500642065Medicaid
WA8488538Medicaid
ORP01178825OtherRR MEDICARE - PHS
ORR166715Medicare PIN
ORR161500Medicare PIN