Provider Demographics
NPI:1831164037
Name:MARSHALL, SHERI TAMARA (MD)
Entity type:Individual
Prefix:DR
First Name:SHERI
Middle Name:TAMARA
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHERI
Other - Middle Name:TAMARA
Other - Last Name:MELTESEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:816 INDEPENDENCE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6010
Mailing Address - Country:US
Mailing Address - Phone:757-363-6800
Mailing Address - Fax:757-507-9023
Practice Address - Street 1:816 INDEPENDENCE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6010
Practice Address - Country:US
Practice Address - Phone:757-363-6800
Practice Address - Fax:757-507-9023
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056239207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005639239Medicaid
003547S33Medicare ID - Type Unspecified
G93721Medicare UPIN