Provider Demographics
NPI:1962590737
Name:CLEMENTS, SHERI ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:SHERI
Middle Name:ANNE
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 HIGHLAND RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1913
Mailing Address - Country:US
Mailing Address - Phone:248-383-1030
Mailing Address - Fax:248-383-1031
Practice Address - Street 1:5220 HIGHLAND RD
Practice Address - Street 2:SUITE 210
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1975
Practice Address - Country:US
Practice Address - Phone:248-383-1030
Practice Address - Fax:248-383-1031
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003535363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1456318220OtherBCBSM
MIM99600008Medicare PIN