Provider Demographics
NPI:1477008381
Name:SHAPPY, JERI HELENE (MED, MSED)
Entity Type:Individual
Prefix:
First Name:JERI
Middle Name:HELENE
Last Name:SHAPPY
Suffix:
Gender:F
Credentials:MED, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 RAMAPO AVE
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-5941
Mailing Address - Country:US
Mailing Address - Phone:201-786-8112
Mailing Address - Fax:
Practice Address - Street 1:42 RAMAPO AVE
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-5941
Practice Address - Country:US
Practice Address - Phone:201-786-8112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-20
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171M0000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist