Provider Demographics
NPI:1568518751
Name:BLOOM, SHERRY JOY (FNP)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:JOY
Last Name:BLOOM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 COLD SPRING RD
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3142
Mailing Address - Country:US
Mailing Address - Phone:516-822-2541
Mailing Address - Fax:516-822-1787
Practice Address - Street 1:87 COLD SPRING RD
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-3142
Practice Address - Country:US
Practice Address - Phone:516-822-2541
Practice Address - Fax:516-822-1787
Is Sole Proprietor?:No
Enumeration Date:2007-01-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333979-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily