Provider Demographics
NPI:1427028877
Name:SHUNDOFF, SHERYL K (PHD)
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:K
Last Name:SHUNDOFF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 4TH AVENUE
Mailing Address - Street 2:SUITE 32
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-2884
Mailing Address - Country:US
Mailing Address - Phone:308-234-6029
Mailing Address - Fax:308-237-4792
Practice Address - Street 1:4111 4TH AVENUE
Practice Address - Street 2:SUITE 32
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-2884
Practice Address - Country:US
Practice Address - Phone:308-234-6029
Practice Address - Fax:308-237-4792
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEPHD172103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47077781326Medicaid
NE47077781326Medicaid
098125Medicare ID - Type Unspecified