Provider Demographics
NPI:1912085523
Name:GARRETT, SHERYL ANNE (MD)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:ANNE
Last Name:GARRETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3536 MENDOCINO AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-3634
Mailing Address - Country:US
Mailing Address - Phone:707-573-6166
Mailing Address - Fax:707-573-6165
Practice Address - Street 1:719 SOUTHPOINT BLVD
Practice Address - Street 2:STE B
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-1495
Practice Address - Country:US
Practice Address - Phone:707-778-8421
Practice Address - Fax:707-778-1702
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG76995207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G769950Medicaid
00G769950Medicare ID - Type Unspecified
CA00G769950Medicaid