Provider Demographics
NPI:1629191291
Name:LONGSHORE, SHERRY R
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:R
Last Name:LONGSHORE
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 1:3641 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4351
Mailing Address - Country:US
Mailing Address - Phone:757-461-4909
Mailing Address - Fax:757-461-4909
Practice Address - Street 1:3641 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4351
Practice Address - Country:US
Practice Address - Phone:757-461-4909
Practice Address - Fax:757-461-4909
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA038368L10430332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies