Provider Demographics
NPI:1942568217
Name:KELL, SHERRON (MD)
Entity Type:Individual
Prefix:
First Name:SHERRON
Middle Name:
Last Name:KELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11060 E JASMINE DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-2417
Mailing Address - Country:US
Mailing Address - Phone:650-224-7038
Mailing Address - Fax:480-502-8902
Practice Address - Street 1:11060 E JASMINE DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-2417
Practice Address - Country:US
Practice Address - Phone:650-224-7038
Practice Address - Fax:480-502-8902
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14162207R00000X
AZ26381207R00000X
CAG86143207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine