Provider Demographics
NPI:1629053699
Name:HAGGERTY, SHERYL ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHERYL
Middle Name:ANN
Last Name:HAGGERTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1416 TOWSE DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95776-6715
Mailing Address - Country:US
Mailing Address - Phone:707-365-7640
Mailing Address - Fax:815-361-9113
Practice Address - Street 1:5290 ELVAS AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-2332
Practice Address - Country:US
Practice Address - Phone:916-739-1507
Practice Address - Fax:815-361-9113
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98050208D00000X
HIMD-12052208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice