Provider Demographics
NPI:1134288962
Name:BERDE, SHERRY
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:BERDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 WACHTLER AVE
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55118-4333
Mailing Address - Country:US
Mailing Address - Phone:651-230-7514
Mailing Address - Fax:
Practice Address - Street 1:3570 LEXINGTON AVE N STE 100
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-8058
Practice Address - Country:US
Practice Address - Phone:651-481-0637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 1429103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6268215OtherMEDICA (UBH)
MNHP18512OtherH PARTNERS