Provider Demographics
NPI:1033727797
Name:ELLIS, SHERRY J (HAIR SPECIALIST)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:J
Last Name:ELLIS
Suffix:
Gender:F
Credentials:HAIR SPECIALIST
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:J
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:123 LIVINGSTON AVE APT A-2
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12207-2318
Mailing Address - Country:US
Mailing Address - Phone:518-210-4765
Mailing Address - Fax:
Practice Address - Street 1:123 LIVINGSTON AVE APT A-2
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12207-2318
Practice Address - Country:US
Practice Address - Phone:518-210-4765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management