Provider Demographics
NPI:1336299874
Name:DORESTANT, SHERLY (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:SHERLY
Middle Name:
Last Name:DORESTANT
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 NOSBAND AVE
Mailing Address - Street 2:APARTMENT 2K
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-2009
Mailing Address - Country:US
Mailing Address - Phone:917-595-9707
Mailing Address - Fax:
Practice Address - Street 1:DAVIS AVE AT EAST POST ROAD
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601
Practice Address - Country:US
Practice Address - Phone:914-681-1158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009295363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical