Provider Demographics
NPI:1306804430
Name:PREVADE, SHERRY (OD)
Entity type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:
Last Name:PREVADE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 E MCMURRAY RD
Mailing Address - Street 2:
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-3419
Mailing Address - Country:US
Mailing Address - Phone:724-941-3930
Mailing Address - Fax:
Practice Address - Street 1:609 E MCMURRAY RD
Practice Address - Street 2:
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-3419
Practice Address - Country:US
Practice Address - Phone:724-941-3930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG-001015152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018518590004Medicaid
PA0018518590004Medicaid
PA007391Medicare ID - Type Unspecified