Provider Demographics
NPI:1447562160
Name:LANDAU, SHERRYL
Entity Type:Individual
Prefix:
First Name:SHERRYL
Middle Name:
Last Name:LANDAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:497 W 182ND ST
Mailing Address - Street 2:APT 5B
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10033-3313
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:497 W 182ND ST
Practice Address - Street 2:APT 5B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3313
Practice Address - Country:US
Practice Address - Phone:917-710-7350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016133225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist