Individual
SHERYL DERDERIAN
Active
Individual
SHERYL DERDERIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
156396
MA
363LA2200X
Adult Health Nurse Practitioner
156396
MA
363LG0600X
Gerontology Nurse Practitioner
Primary
156396
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0344061
—
MA
01
—
500025819
RAILROAD MEDICARE
MA
01
—
NP1137
CONNECTICARE
MA
Enumeration date
10/17/2006
Last updated
08/01/2014
Update your record
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