Provider Demographics
NPI:1114043346
Name:LONGYEAR, SHERRALYN (LMT)
Entity Type:Individual
Prefix:
First Name:SHERRALYN
Middle Name:
Last Name:LONGYEAR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 SHERBURNE RD
Mailing Address - Street 2:
Mailing Address - City:WALWORTH
Mailing Address - State:NY
Mailing Address - Zip Code:14568-9610
Mailing Address - Country:US
Mailing Address - Phone:315-986-8104
Mailing Address - Fax:
Practice Address - Street 1:1830 SHERBURNE RD
Practice Address - Street 2:
Practice Address - City:WALWORTH
Practice Address - State:NY
Practice Address - Zip Code:14568-9610
Practice Address - Country:US
Practice Address - Phone:315-986-8104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010733225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist