Provider Demographics
NPI:1679678189
Name:MARY T. SHERIFF, DPM
Entity Type:Organization
Organization Name:MARY T. SHERIFF, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:SHERIFF
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:504-283-6754
Mailing Address - Street 1:43162 PECAN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-0602
Mailing Address - Country:US
Mailing Address - Phone:985-902-7785
Mailing Address - Fax:985-902-7780
Practice Address - Street 1:4301 ELYSIAN FIELDS AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-3875
Practice Address - Country:US
Practice Address - Phone:504-283-6754
Practice Address - Fax:504-283-9949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD318R213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1162183Medicaid
LAPD318ROtherLA STATE LICENSE
LAPD318ROtherLA STATE LICENSE
LA1162183Medicaid
LA5311930001Medicare NSC