Provider Demographics
NPI:1720382542
Name:SHEREDA, JULIE ANN (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:SHEREDA
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:FEDEWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP-BC
Mailing Address - Street 1:2799 W GRAND BLVD # B1439
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2689
Mailing Address - Country:US
Mailing Address - Phone:313-916-2689
Mailing Address - Fax:313-916-2687
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-2695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-08
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704231076363LA2100X
IAL131922363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care