Provider Demographics
NPI:1508386442
Name:ABDOLI, SHERWIN (MD)
Entity type:Individual
Prefix:
First Name:SHERWIN
Middle Name:
Last Name:ABDOLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:400 N MCDOWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-2339
Mailing Address - Country:US
Mailing Address - Phone:707-303-1709
Mailing Address - Fax:707-476-2235
Practice Address - Street 1:400 N MCDOWELL BLVD
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-2339
Practice Address - Country:US
Practice Address - Phone:707-303-1709
Practice Address - Fax:707-476-2235
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA156958208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery