Basic Information
| Provider Information | |||||||||
| NPI: | 1427243245 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHERWOOD | ||||||||
| FirstName: | MYLAINA | ||||||||
| MiddleName: | LYN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95 LEONARD AVE | ||||||||
| Address2: | BLDG 2 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 153013368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7242233100 | ||||||||
| FaxNumber: | 7242233353 | ||||||||
| Practice Location | |||||||||
| Address1: | 3415 MILLERS RUN RD | ||||||||
| Address2: | |||||||||
| City: | CECIL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 153211403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7248737414 | ||||||||
| FaxNumber: | 7248737421 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2007 | ||||||||
| LastUpdateDate: | 03/31/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ML002805 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00754785 | 01 | RAILROAD MEDICARE | OTHER | 1985059 | 01 | PA | HIGHMARK | OTHER | 730501 | 01 | UPMC | OTHER | 1020140260004 | 05 | PA | MEDICAID | 276599 | 01 | PA | UNISON | OTHER | P010202 | 01 | GATEWAY | OTHER |