Provider Demographics
NPI:1023066818
Name:DAGOSTINO, SHERRI L (APN)
Entity type:Individual
Prefix:MS
First Name:SHERRI
Middle Name:L
Last Name:DAGOSTINO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MS
Other - First Name:SHERRI
Other - Middle Name:L
Other - Last Name:RUPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2116 KENTUCKY CT
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187
Mailing Address - Country:US
Mailing Address - Phone:630-784-0012
Mailing Address - Fax:630-784-0013
Practice Address - Street 1:880 W CENTRAL RD
Practice Address - Street 2:SUITE 6400 CHILDRENS MEMORIAL OUTPT CENTER
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005
Practice Address - Country:US
Practice Address - Phone:224-625-2180
Practice Address - Fax:224-625-2182
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005747208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q65554Medicare UPIN