Provider Demographics
NPI:1275968653
Name:CORBIN, SHERRIE AMELIA (LPN)
Entity Type:Individual
Prefix:MISS
First Name:SHERRIE
Middle Name:AMELIA
Last Name:CORBIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11219 34TH AVE
Mailing Address - Street 2:APT 6B
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-1458
Mailing Address - Country:US
Mailing Address - Phone:917-604-7118
Mailing Address - Fax:
Practice Address - Street 1:11219 34TH AVE
Practice Address - Street 2:APT 6B
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368
Practice Address - Country:US
Practice Address - Phone:917-604-7118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-04
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312079164W00000X
NY715076163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No164W00000XNursing Service ProvidersLicensed Practical Nurse