Provider Demographics
NPI:1124540869
Name:FERNANDO, SHERAN (MD)
Entity type:Individual
Prefix:
First Name:SHERAN
Middle Name:
Last Name:FERNANDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ROSARY DR
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:IA
Mailing Address - Zip Code:50841-1683
Mailing Address - Country:US
Mailing Address - Phone:641-322-5245
Mailing Address - Fax:641-322-4687
Practice Address - Street 1:461 WEST HURON STREET
Practice Address - Street 2:PONTIAC GENERAL HOSPITAL CLINIC
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341
Practice Address - Country:US
Practice Address - Phone:248-857-6700
Practice Address - Fax:248-857-7141
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD46877207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine