Provider Demographics
NPI:1730159716
Name:TYSCH, SHERRI R (DO)
Entity type:Individual
Prefix:DR
First Name:SHERRI
Middle Name:R
Last Name:TYSCH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1250 LA VENTA DR STE 103
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-3757
Mailing Address - Country:US
Mailing Address - Phone:805-495-0841
Mailing Address - Fax:805-446-4891
Practice Address - Street 1:1250 LA VENTA DR STE 103
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-3757
Practice Address - Country:US
Practice Address - Phone:805-495-0841
Practice Address - Fax:805-446-4891
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A5794208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics