Provider Demographics
NPI:1720048200
Name:BURCHELL, SHERRY A (MD)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:A
Last Name:BURCHELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:999 N TUSTIN AVE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3528
Mailing Address - Country:US
Mailing Address - Phone:714-547-1915
Mailing Address - Fax:714-547-6552
Practice Address - Street 1:999 N TUSTIN AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3528
Practice Address - Country:US
Practice Address - Phone:714-547-1915
Practice Address - Fax:714-547-6552
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG841722086S0127X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGG66797Medicare UPIN