Provider Demographics
NPI:1447283411
Name:SHERRY F YUDELL M D INC
Entity type:Organization
Organization Name:SHERRY F YUDELL M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:F
Authorized Official - Last Name:YUDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-991-0209
Mailing Address - Street 1:PO BOX 55152
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91385-0152
Mailing Address - Country:US
Mailing Address - Phone:661-298-7423
Mailing Address - Fax:661-298-7423
Practice Address - Street 1:17609 VENTURA BLVD
Practice Address - Street 2:SUITE 114
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-5119
Practice Address - Country:US
Practice Address - Phone:818-991-0209
Practice Address - Fax:888-340-0712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG70002208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G700020Medicaid
CA00G700020Medicaid
CAG70002Medicare ID - Type Unspecified