Provider Demographics
NPI:1174824759
Name:SHERWOOD, JAIME
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:SHERWOOD
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 1:114 BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:NY
Mailing Address - Zip Code:13808
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:114 BROAD STREET
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:NY
Practice Address - Zip Code:13808
Practice Address - Country:US
Practice Address - Phone:518-225-1402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15700-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics