Provider Demographics
NPI:1003290396
Name:KERN, SHEILA A (PA-C)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:A
Last Name:KERN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82-68 164TH STREET
Mailing Address - Street 2:QUEENS HOSPITAL CENTER
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432
Mailing Address - Country:US
Mailing Address - Phone:718-883-4133
Mailing Address - Fax:718-883-6295
Practice Address - Street 1:8268 164TH ST
Practice Address - Street 2:ROOM A531
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1121
Practice Address - Country:US
Practice Address - Phone:718-883-4133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018687-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYSK606931OtherHEALTH COMMERCE SYSTEM (HCS)