Provider Demographics
NPI:1700162989
Name:SHERDON, JOHN (DOM, LIC AC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:SHERDON
Suffix:
Gender:M
Credentials:DOM, LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7608 OLD SANTA FE TRL
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-9359
Mailing Address - Country:US
Mailing Address - Phone:505-989-4610
Mailing Address - Fax:505-989-4126
Practice Address - Street 1:7608 OLD SANTA FE TRL
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-9359
Practice Address - Country:US
Practice Address - Phone:505-989-4610
Practice Address - Fax:505-989-4126
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM994171100000X
NY004048-1171100000X
TXAC01128171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist