Provider Demographics
NPI:1629810544
Name:FORBES, SHERRY PAMELA
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:PAMELA
Last Name:FORBES
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 1:24406 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH DINWIDDIE
Mailing Address - State:VA
Mailing Address - Zip Code:23803-9434
Mailing Address - Country:US
Mailing Address - Phone:252-205-8361
Mailing Address - Fax:
Practice Address - Street 1:24406 LAKE DR
Practice Address - Street 2:
Practice Address - City:NORTH DINWIDDIE
Practice Address - State:VA
Practice Address - Zip Code:23803-9434
Practice Address - Country:US
Practice Address - Phone:252-205-8361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA3293171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty