1265435838 NPI number — DR. SHERI L SPUNT MD

Table of content: DR. SHERI L SPUNT MD (NPI 1265435838)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265435838 NPI number — DR. SHERI L SPUNT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPUNT
Provider First Name:
SHERI
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265435838
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1804 EMBARCADERO RD
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
PALO ALTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94303-3318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-723-2325
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
262 DANNY THOMAS PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38105-3678
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-595-3006
Provider Business Practice Location Address Fax Number:
901-595-3842
Provider Enumeration Date:
05/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080P0207X , with the licence number:  30595 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0207X , with the licence number: G78956 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1135601 00 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 135481001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3897685 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 422400000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64929524 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0527929 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 107503801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q30595 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00119518 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100204410A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7614366 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0030937 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2064608 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 205030307 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200192330A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009912990 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1561371 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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