Provider Demographics
NPI:1255407151
Name:STEVENS, SHERRY L (DO)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:L
Last Name:STEVENS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6905 HOSPITAL DR
Mailing Address - Street 2:STE 130
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-9600
Mailing Address - Country:US
Mailing Address - Phone:614-546-4967
Mailing Address - Fax:614-546-4441
Practice Address - Street 1:6150 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1574
Practice Address - Country:US
Practice Address - Phone:614-546-4967
Practice Address - Fax:614-546-4441
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34006489207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4204271Medicare PIN
G54922Medicare UPIN