Provider Demographics
NPI:1144463845
Name:SHERBOURNE, BOYD DAVID (PSYD)
Entity type:Individual
Prefix:DR
First Name:BOYD
Middle Name:DAVID
Last Name:SHERBOURNE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 SUPERIOR CT STE 110
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6179
Mailing Address - Country:US
Mailing Address - Phone:541-944-3938
Mailing Address - Fax:
Practice Address - Street 1:670 SUPERIOR CT STE 110
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6179
Practice Address - Country:US
Practice Address - Phone:541-944-3938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1976103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical