Provider Demographics
NPI:1093104770
Name:AGENA, SHERLINE (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:SHERLINE
Middle Name:
Last Name:AGENA
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 SHIRLEY LN
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-1317
Mailing Address - Country:US
Mailing Address - Phone:347-517-5830
Mailing Address - Fax:
Practice Address - Street 1:416 ROUTE 25A
Practice Address - Street 2:
Practice Address - City:E. SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733
Practice Address - Country:US
Practice Address - Phone:347-517-5830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-17
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT536175F00000X
NY006294-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No175F00000XOther Service ProvidersNaturopath