Provider Demographics
NPI:1952141350
Name:SHERMAN, MACKENZIE FAITH (PA-C)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:FAITH
Last Name:SHERMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 RICCARDI DR
Mailing Address - Street 2:
Mailing Address - City:DRUMS
Mailing Address - State:PA
Mailing Address - Zip Code:18222-2746
Mailing Address - Country:US
Mailing Address - Phone:507-582-7325
Mailing Address - Fax:
Practice Address - Street 1:200 ST LUKES LN STE 200
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-6218
Practice Address - Country:US
Practice Address - Phone:484-526-1735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA066019363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical