Provider Demographics
NPI:1023194164
Name:ROBERTS-MCKAY, DELLA SHERYL (OD)
Entity Type:Individual
Prefix:DR
First Name:DELLA
Middle Name:SHERYL
Last Name:ROBERTS-MCKAY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 ROUTE 59 STE 4
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-5236
Mailing Address - Country:US
Mailing Address - Phone:845-371-6640
Mailing Address - Fax:
Practice Address - Street 1:205 ROUTE 59 STE 4
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-5236
Practice Address - Country:US
Practice Address - Phone:845-371-6640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYUVT005533152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC06811Medicare UPIN
NY01475456Medicare ID - Type Unspecified