Provider Demographics
NPI:1336717511
Name:HERNANDEZ, SHERRYL
Entity Type:Individual
Prefix:
First Name:SHERRYL
Middle Name:
Last Name:HERNANDEZ
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 1:2605 W VLIET ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53205-1837
Mailing Address - Country:US
Mailing Address - Phone:414-406-7166
Mailing Address - Fax:414-933-3397
Practice Address - Street 1:2605 W VLIET ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53205-1837
Practice Address - Country:US
Practice Address - Phone:414-406-7166
Practice Address - Fax:414-933-3397
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator