1033342225 NPI number — MRS. SHERRIE J DOMB B.A.,M.S.

Table of content: MRS. SHERRIE J DOMB B.A.,M.S. (NPI 1033342225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033342225 NPI number — MRS. SHERRIE J DOMB B.A.,M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOMB
Provider First Name:
SHERRIE
Provider Middle Name:
J
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
B.A.,M.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHNEIDER
Provider Other First Name:
SHERRIE
Provider Other Middle Name:
JOY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033342225
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6700 WASHINGTON AVE S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDEN PRAIRIE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55344-3405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-328-8602
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
123 N CONGRESS AVE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOYNTON BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33426-5132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-285-4020
Provider Business Practice Location Address Fax Number:
503-659-5968
Provider Enumeration Date:
09/03/2009

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: 231H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 237600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: HB811Z . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: HB811Y . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".