Provider Demographics
NPI:1336662246
Name:SHERMAN, KEITH RICHARD MICHAEL (DPM)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:RICHARD MICHAEL
Last Name:SHERMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7075 MANLIUS CENTER RD
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-2607
Mailing Address - Country:US
Mailing Address - Phone:914-488-4802
Mailing Address - Fax:
Practice Address - Street 1:7075 MANLIUS CENTER RD
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-2607
Practice Address - Country:US
Practice Address - Phone:315-446-3668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN007166213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery