Provider Demographics
NPI:1164415493
Name:RANSOM, SHERRY MARIA (DPM)
Entity Type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:MARIA
Last Name:RANSOM
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 NORTH COLUMBUS AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MT. VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-2332
Mailing Address - Country:US
Mailing Address - Phone:914-668-5296
Mailing Address - Fax:914-668-5302
Practice Address - Street 1:360 NORTH COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:MT. VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-2032
Practice Address - Country:US
Practice Address - Phone:914-668-5296
Practice Address - Fax:914-668-5302
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004514213E00000X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP46922OtherEMPIRE
NY01127944Medicaid
NYP2728330OtherOXFORD
T82990Medicare UPIN
NYP46922OtherEMPIRE