Provider Demographics
NPI:1831119098
Name:BEAL, SHERI BOOTH (PA-C)
Entity Type:Individual
Prefix:
First Name:SHERI
Middle Name:BOOTH
Last Name:BEAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-643-5800
Mailing Address - Fax:336-643-7474
Practice Address - Street 1:4901 AUBURN RD
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:NC
Practice Address - Zip Code:27358-9233
Practice Address - Country:US
Practice Address - Phone:336-660-5270
Practice Address - Fax:336-660-5289
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103759363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1212660004OtherDME
NC2764272AMedicare PIN
Q52381Medicare UPIN
NC2764272Medicare PIN