Provider Demographics
NPI:1922192764
Name:SHERMAN, NARDA MELISSA (PA-C)
Entity Type:Individual
Prefix:
First Name:NARDA
Middle Name:MELISSA
Last Name:SHERMAN
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 1:16420 SE DIVISION STREET
Mailing Address - Street 2:PORTLAND METRO TREATMENT CENTER
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-1987
Mailing Address - Country:US
Mailing Address - Phone:503-762-3130
Mailing Address - Fax:503-288-7538
Practice Address - Street 1:501 N GRAHAM ST
Practice Address - Street 2:SUITE 555
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1654
Practice Address - Country:US
Practice Address - Phone:503-288-7535
Practice Address - Fax:503-288-7538
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00799363AS0400X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P56233Medicare UPIN