Provider Demographics
NPI:1336298918
Name:PHIPPEN-GESUALDI, SHERRY L (MD)
Entity type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:L
Last Name:PHIPPEN-GESUALDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1333 S SAM HOUSTON BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MO
Mailing Address - Zip Code:65483-2046
Mailing Address - Country:US
Mailing Address - Phone:417-967-1252
Mailing Address - Fax:417-967-0417
Practice Address - Street 1:1333 S SAM HOUSTON BLVD STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MO
Practice Address - Zip Code:65483-2046
Practice Address - Country:US
Practice Address - Phone:417-967-1252
Practice Address - Fax:417-967-0417
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2002021119208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205982101Medicaid
MO205982101Medicaid
MO159013230Medicare PIN