Provider Demographics
NPI:1730540469
Name:DELICH, SHERI LYNN
Entity type:Individual
Prefix:
First Name:SHERI
Middle Name:LYNN
Last Name:DELICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHERI
Other - Middle Name:LYNN
Other - Last Name:MEINERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5284 TAYLOR ST NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55421-1857
Mailing Address - Country:US
Mailing Address - Phone:651-500-1838
Mailing Address - Fax:
Practice Address - Street 1:5284 TAYLOR ST NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55421-1857
Practice Address - Country:US
Practice Address - Phone:651-500-1838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR558120061918172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN00876171OtherMHCP MEMBER NUMBER
MNX102141OtherWORKER ID
MN00823837OtherCASE NUMBER