Basic Information
| Provider Information | |||||||||
| NPI: | 1124540869 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FERNANDO | ||||||||
| FirstName: | SHERAN | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 ROSARY DR | ||||||||
| Address2: | |||||||||
| City: | CORNING | ||||||||
| State: | IA | ||||||||
| PostalCode: | 508411683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6413225245 | ||||||||
| FaxNumber: | 6413224687 | ||||||||
| Practice Location | |||||||||
| Address1: | 461 WEST HURON STREET | ||||||||
| Address2: | PONTIAC GENERAL HOSPITAL CLINIC | ||||||||
| City: | PONTIAC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488576700 | ||||||||
| FaxNumber: | 2488577141 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2017 | ||||||||
| LastUpdateDate: | 07/22/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD46877 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.