Provider Demographics
NPI:1073563359
Name:KORNFELD, SHERRY SEITLIN (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:SEITLIN
Last Name:KORNFELD
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3007 SIMMON TREE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-0676
Mailing Address - Country:US
Mailing Address - Phone:704-995-2900
Mailing Address - Fax:
Practice Address - Street 1:3007 SIMMON TREE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-0676
Practice Address - Country:US
Practice Address - Phone:704-995-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4679235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412224Medicaid