Provider Demographics
NPI:1568786853
Name:SHERMAN, DIANE MARIE
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:SHERMAN
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 1:13 JAMES P KELLY WAY STE F
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-7395
Mailing Address - Country:US
Mailing Address - Phone:845-467-4064
Mailing Address - Fax:845-467-4069
Practice Address - Street 1:13 JAMES P KELLY WAY STE F
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-7395
Practice Address - Country:US
Practice Address - Phone:845-467-4064
Practice Address - Fax:845-467-4069
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042007183500000X
MAPH 20255183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist