Provider Demographics
NPI:1205803251
Name:COLEMAN, SHERYLL CHANDLER (PA)
Entity type:Individual
Prefix:
First Name:SHERYLL
Middle Name:CHANDLER
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 LITTLE FAWN LN
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-6410
Mailing Address - Country:US
Mailing Address - Phone:205-620-0033
Mailing Address - Fax:
Practice Address - Street 1:124 LITTLE FAWN LN
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-6410
Practice Address - Country:US
Practice Address - Phone:205-620-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA008363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51519908COLOtherBLUE CROSS/BLUE SHIELD
AL51519908COLOtherBLUE CROSS/BLUE SHIELD
AL051519908COLMedicare ID - Type Unspecified