Provider Demographics
NPI:1417208448
Name:GATLING, SHERRY L (HAIR STYLIST)
Entity Type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:L
Last Name:GATLING
Suffix:
Gender:F
Credentials:HAIR STYLIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 FREIGHT STREET #1
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702
Mailing Address - Country:US
Mailing Address - Phone:203-206-1412
Mailing Address - Fax:203-753-9453
Practice Address - Street 1:394 MILL STREET
Practice Address - Street 2:2ND FLR N
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06706
Practice Address - Country:US
Practice Address - Phone:203-206-1412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1962OtherHAIR AND SKIN PRODUCTS
CT1962OtherPROVIDER FOR CRANIAL PROSTHESIS
CT1962Medicare PIN
CT1962OtherHAIR AND SKIN PRODUCTS