Provider Demographics
NPI:1992825368
Name:CHERVIL, SHEILA BRUN (PA)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:BRUN
Last Name:CHERVIL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:
Other - Last Name:BRUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 602478
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2478
Mailing Address - Country:US
Mailing Address - Phone:704-801-2000
Mailing Address - Fax:704-801-2001
Practice Address - Street 1:10210 COULOAK DR
Practice Address - Street 2:SUITE E
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-7679
Practice Address - Country:US
Practice Address - Phone:704-801-2000
Practice Address - Fax:704-801-2001
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-03899363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8103041Medicaid
NC1992825368Medicaid
NCNCB535EMedicare PIN
NCNCB535AMedicare PIN
NCNCB535BMedicare PIN
NCNCB535DMedicare PIN
NCNCB535AMedicare UPIN
NC8103041Medicaid
NCNCB535GMedicare PIN
NCNCB535FMedicare PIN