Provider Demographics
NPI:1205861234
Name:WHEATON, SHERILYN CHANTAL (MD)
Entity type:Individual
Prefix:DR
First Name:SHERILYN
Middle Name:CHANTAL
Last Name:WHEATON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHERILYN
Other - Middle Name:C
Other - Last Name:TOGNAZZINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2772 JOHNSON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7262
Mailing Address - Country:US
Mailing Address - Phone:805-642-1430
Mailing Address - Fax:805-642-1436
Practice Address - Street 1:10885 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004-1272
Practice Address - Country:US
Practice Address - Phone:805-642-1430
Practice Address - Fax:805-642-1436
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA229681207Q00000X
CAA89819207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA77-0368541OtherTAX ID