Provider Demographics
NPI:1629003207
Name:SHERRADEN, TERRY WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:WAYNE
Last Name:SHERRADEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2633 CENTENNIAL BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-0585
Mailing Address - Country:US
Mailing Address - Phone:850-877-7387
Mailing Address - Fax:850-656-3376
Practice Address - Street 1:2406 E PLAZA DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5301
Practice Address - Country:US
Practice Address - Phone:850-877-7387
Practice Address - Fax:850-656-3376
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0045932174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL39961Medicare ID - Type Unspecified
FLD54642Medicare UPIN