Provider Demographics
NPI:1912187386
Name:DEVINE, SHERRAL A (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHERRAL
Middle Name:A
Last Name:DEVINE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 GARRISON CIR
Mailing Address - Street 2:
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532-2710
Mailing Address - Country:US
Mailing Address - Phone:508-868-9484
Mailing Address - Fax:
Practice Address - Street 1:2 GARRISON CIR
Practice Address - Street 2:
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-2710
Practice Address - Country:US
Practice Address - Phone:508-868-9484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7450103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist