Provider Demographics
NPI:1750057253
Name:CASSIDY, SHERRI (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 AUGUSTA HWY
Mailing Address - Street 2:
Mailing Address - City:SMOAKS
Mailing Address - State:SC
Mailing Address - Zip Code:29481-6105
Mailing Address - Country:US
Mailing Address - Phone:843-562-6480
Mailing Address - Fax:
Practice Address - Street 1:12930 BROXTON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:EHRHARDT
Practice Address - State:SC
Practice Address - Zip Code:29081
Practice Address - Country:US
Practice Address - Phone:843-562-6480
Practice Address - Fax:803-267-2124
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25011363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily