Provider Demographics
NPI:1366611774
Name:ANDERSON, SHERRI N (PA)
Entity type:Individual
Prefix:
First Name:SHERRI
Middle Name:N
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:32144 AGOURA RD STE 112
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-4043
Mailing Address - Country:US
Mailing Address - Phone:818-889-2739
Mailing Address - Fax:818-889-2747
Practice Address - Street 1:32144 AGOURA RD STE 112
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-4043
Practice Address - Country:US
Practice Address - Phone:818-889-2739
Practice Address - Fax:818-889-2747
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD0110002719207P00000X
CA57066363A00000X
CAPA57066363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine