Provider Demographics
NPI:1982828935
Name:SUKOL, SHERRY M (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:M
Last Name:SUKOL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 TREATY DRIVE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-5510
Mailing Address - Country:US
Mailing Address - Phone:610-640-0423
Mailing Address - Fax:
Practice Address - Street 1:14 ELLIOTT AVENUE
Practice Address - Street 2:SUITE 3
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3412
Practice Address - Country:US
Practice Address - Phone:610-526-2226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003349L103T00000X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABS152649Medicare ID - Type Unspecified