Sherill Alethia Broderick, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

2023190695 Issued in GA

Practice address

3650 Lilly Brook Dr
Loganville, GA 30052-3391

Phone

(201) 580-0480

NPI assigned

Mar 28, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Miss Sherill Alethia Broderick Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1711584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711584000000",
    "number": "1699526723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3650 LILLY BROOK DR",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300523391",
            "telephone_number": "201-898-8574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3650 LILLY BROOK DR",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300523391",
            "telephone_number": "201-580-0480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODERICK",
        "first_name": "SHERILL",
        "middle_name": "ALETHIA",
        "name_prefix": "Miss",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-28",
        "last_updated": "2024-03-28",
        "certification_date": "2024-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "GA",
            "license": "2023190695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHERILL",
            "last_name": "BRODERICK",
            "middle_name": "ALETHIA",
            "prefix": "MISS",
            "credential": "NP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Bridging Legacies II
• Persis Bristol, CD
• Morgan Lee Brooks
• Walter Brooks III, PT, DPT
• Darien Brown
• Qiarra Brown
• Steven Brown, DC

• Psychiatric/Mental Health Nurse Practitioner in Loganville, GA
• Providers in Loganville, GA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.