Basic Information
Provider Information
NPI: 1346431558
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SHERMAN
FirstName: HALI
MiddleName: O
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1601 FRUITVALE AVE
Address2:  
City: OAKLAND
State: CA
PostalCode: 946012418
CountryCode: US
TelephoneNumber: 5105354000
FaxNumber: 5105354128
Practice Location
Address1: 1030 INTERNATIONAL BLVD
Address2:  
City: OAKLAND
State: CA
PostalCode: 946063730
CountryCode: US
TelephoneNumber: 5105354000
FaxNumber: 5105354128
Other Information
ProviderEnumerationDate: 08/05/2007
LastUpdateDate: 12/15/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000XA89388CAY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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