Provider Demographics
NPI:1780971846
Name:HANAWALT, SHERYL L (DPM)
Entity type:Individual
Prefix:DR
First Name:SHERYL
Middle Name:L
Last Name:HANAWALT
Suffix:
Gender:F
Credentials:DPM
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Mailing Address - Street 1:222 S WOODS MILL RD STE 440N
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3625
Mailing Address - Country:US
Mailing Address - Phone:314-434-7430
Mailing Address - Fax:314-434-8768
Practice Address - Street 1:222 S WOODS MILL RD STE 440N
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3625
Practice Address - Country:US
Practice Address - Phone:314-434-7430
Practice Address - Fax:314-434-8768
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2011021444213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50070767OtherPASSPORT HEALTH PLAN
INP01370623OtherRAILROAD MEDICARE
KY000000879046OtherANTHEM
IN201243010Medicaid
KY7100308110Medicaid
KY7100308110Medicaid
KY50070767OtherPASSPORT HEALTH PLAN