Provider Demographics
NPI:1083082457
Name:ANDERSON, SHERRYROSE JULIA
Entity Type:Individual
Prefix:MS
First Name:SHERRYROSE
Middle Name:JULIA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-6932
Mailing Address - Country:US
Mailing Address - Phone:631-902-2187
Mailing Address - Fax:
Practice Address - Street 1:128 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-6932
Practice Address - Country:US
Practice Address - Phone:631-902-2187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst