Provider Demographics
NPI:1679860910
Name:SHEERIN, LORI ANN (MED)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:SHEERIN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 CARLILE AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-1018
Mailing Address - Country:US
Mailing Address - Phone:703-843-7334
Mailing Address - Fax:703-843-7334
Practice Address - Street 1:312 CARLILE AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-1018
Practice Address - Country:US
Practice Address - Phone:703-843-7334
Practice Address - Fax:719-544-0773
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPGP-109943222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist