Provider Demographics
NPI:1942397427
Name:SHERVANICK, PAMELA (DO)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:SHERVANICK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 WENTWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02905-2705
Mailing Address - Country:US
Mailing Address - Phone:401-270-6484
Mailing Address - Fax:
Practice Address - Street 1:55 JOHN A CUMMINGS WAY
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-3247
Practice Address - Country:US
Practice Address - Phone:401-235-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO005852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1529682OtherUNITED HEALTH
RI0000031246OtherBLUE CROSS
RI413214OtherBLUE CHIP
RI9001890Medicaid