Provider Demographics
NPI:1710930037
Name:ANDERSON, SHERMANE M (PAC)
Entity Type:Individual
Prefix:
First Name:SHERMANE
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 WHITING HILL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1006
Mailing Address - Country:US
Mailing Address - Phone:207-973-5461
Mailing Address - Fax:
Practice Address - Street 1:1 NORTHEAST DR
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4332
Practice Address - Country:US
Practice Address - Phone:207-927-5380
Practice Address - Fax:207-275-3803
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-797363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEAP1865Medicare ID - Type Unspecified