Provider Demographics
NPI:1669656948
Name:THOTAM, SHERIN LIONEL (RN)
Entity Type:Individual
Prefix:
First Name:SHERIN
Middle Name:LIONEL
Last Name:THOTAM
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 1:901 NESCONSET HWY
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-1064
Mailing Address - Country:US
Mailing Address - Phone:631-780-6564
Mailing Address - Fax:
Practice Address - Street 1:901 NESCONSET HWY
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-1064
Practice Address - Country:US
Practice Address - Phone:631-780-6564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-23
Last Update Date:2007-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY451950-1163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical