Provider Demographics
NPI:1497089957
Name:BLAKE, SHERENE TAMIKA (RN)
Entity Type:Individual
Prefix:MISS
First Name:SHERENE
Middle Name:TAMIKA
Last Name:BLAKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 PERRY ST
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-5220
Mailing Address - Country:US
Mailing Address - Phone:516-483-3439
Mailing Address - Fax:
Practice Address - Street 1:140 PERRY ST
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-5220
Practice Address - Country:US
Practice Address - Phone:516-483-3439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY580784-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse