Provider Demographics
NPI:1790034163
Name:WATSON, SHERYL HADAWAY (PA-C)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:HADAWAY
Last Name:WATSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHERYL
Other - Middle Name:LYNN
Other - Last Name:HADAWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:355 W 16TH STREET
Practice Address - Street 2:STE 3200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2280
Practice Address - Country:US
Practice Address - Phone:317-948-5450
Practice Address - Fax:317-963-7533
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001444A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN262210009Medicare PIN
IN262210009Medicare PIN