Provider Demographics
NPI:1215588272
Name:NALLAS, SHERI ALYSSA
Entity Type:Individual
Prefix:
First Name:SHERI ALYSSA
Middle Name:
Last Name:NALLAS
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 1:1916 WALLACE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-3297
Mailing Address - Country:US
Mailing Address - Phone:917-517-1163
Mailing Address - Fax:
Practice Address - Street 1:1916 WALLACE AVE APT 2
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-3297
Practice Address - Country:US
Practice Address - Phone:917-517-1163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-21
Last Update Date:2019-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY690519163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse