Provider Demographics
NPI:1023241627
Name:COTA, SHERYL L
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:L
Last Name:COTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2370 EDGERTON ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE CANADA
Mailing Address - State:MN
Mailing Address - Zip Code:55117-1619
Mailing Address - Country:US
Mailing Address - Phone:612-991-3249
Mailing Address - Fax:
Practice Address - Street 1:2370 EDGERTON ST
Practice Address - Street 2:
Practice Address - City:LITTLE CANADA
Practice Address - State:MN
Practice Address - Zip Code:55117-1619
Practice Address - Country:US
Practice Address - Phone:612-991-3249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-29
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1452171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist