Provider Demographics
NPI:1871596072
Name:PAVLICK, SHERRYL D (RN,C,MSN,CRNP)
Entity type:Individual
Prefix:MRS
First Name:SHERRYL
Middle Name:D
Last Name:PAVLICK
Suffix:
Gender:F
Credentials:RN,C,MSN,CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 6TH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15234-2737
Mailing Address - Country:US
Mailing Address - Phone:412-469-7933
Mailing Address - Fax:412-469-7024
Practice Address - Street 1:575 COAL VALLEY RD
Practice Address - Street 2:STE 407
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15025-3726
Practice Address - Country:US
Practice Address - Phone:412-469-7933
Practice Address - Fax:412-469-7024
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP005719L363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA031996OtherPIN
PAS95223Medicare UPIN