Provider Demographics
NPI:1578887949
Name:SCAMMACCA, SHERRY (RN)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:SCAMMACCA
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 1:348 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-4840
Mailing Address - Country:US
Mailing Address - Phone:631-796-2374
Mailing Address - Fax:
Practice Address - Street 1:348 W 24TH ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-4840
Practice Address - Country:US
Practice Address - Phone:631-796-2374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY464477163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse