Provider Demographics
NPI:1942266622
Name:IRELAN, SHERRY ANNE
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:ANNE
Last Name:IRELAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2858 SPRING MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-4228
Mailing Address - Country:US
Mailing Address - Phone:317-755-2169
Mailing Address - Fax:
Practice Address - Street 1:4850 CENTURY PLAZA RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-5476
Practice Address - Country:US
Practice Address - Phone:317-216-2434
Practice Address - Fax:317-216-2431
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06002983A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant