Provider Demographics
NPI:1013504083
Name:RAABE, SHERRY LYNN (PHDHP)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:LYNN
Last Name:RAABE
Suffix:
Gender:F
Credentials:PHDHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 CHERRY RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:WEST SUNBURY
Mailing Address - State:PA
Mailing Address - Zip Code:16061-2234
Mailing Address - Country:US
Mailing Address - Phone:814-229-9352
Mailing Address - Fax:
Practice Address - Street 1:106 CHERRY RIDGE LN
Practice Address - Street 2:
Practice Address - City:WEST SUNBURY
Practice Address - State:PA
Practice Address - Zip Code:16061-2234
Practice Address - Country:US
Practice Address - Phone:814-229-9352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-24
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH069520124Q00000X
PAPHDH0002481223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA124Q00000XMedicaid