Provider Demographics
NPI:1730524695
Name:FERNANDES, SHERRIE ANN (PA-C)
Entity type:Individual
Prefix:
First Name:SHERRIE
Middle Name:ANN
Last Name:FERNANDES
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 1:1990 LARKIN AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-5827
Mailing Address - Country:US
Mailing Address - Phone:847-289-5727
Mailing Address - Fax:
Practice Address - Street 1:1990 LARKIN AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5827
Practice Address - Country:US
Practice Address - Phone:847-289-5727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085004641363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical