Provider Demographics
NPI:1063562577
Name:SHERMAN, KELLEY (LAC)
Entity type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:
Last Name:SHERMAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 PENN PLZ
Mailing Address - Street 2:SUITE 22
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3620
Mailing Address - Country:US
Mailing Address - Phone:207-947-8077
Mailing Address - Fax:207-947-3721
Practice Address - Street 1:16 PENN PLZ
Practice Address - Street 2:SUITE 22
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3620
Practice Address - Country:US
Practice Address - Phone:207-947-8077
Practice Address - Fax:207-947-3721
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC291171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist