Provider Demographics
NPI:1275818338
Name:LATASSA, SHERRY (FNP)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:LATASSA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:
Other - Last Name:LAPERCHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:11 RONNIE LN
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-5827
Mailing Address - Country:US
Mailing Address - Phone:845-656-4714
Mailing Address - Fax:
Practice Address - Street 1:70 DUBOIS ST
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-4851
Practice Address - Country:US
Practice Address - Phone:845-561-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF336783-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03480733Medicaid
NYA400131917Medicare PIN