Provider Demographics
NPI:1992891956
Name:CHERIAN, SHEILA (MD)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:CHERIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17207 JASMINE ST.
Mailing Address - Street 2:#2
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-7786
Mailing Address - Country:US
Mailing Address - Phone:760-780-4179
Mailing Address - Fax:760-241-4591
Practice Address - Street 1:17207 JASMINE ST
Practice Address - Street 2:2
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395
Practice Address - Country:US
Practice Address - Phone:760-780-4179
Practice Address - Fax:760-241-4591
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87803207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A878030Medicaid
CA00A878030Medicaid
CA00A878030Medicare ID - Type Unspecified