Provider Demographics
NPI:1669684783
Name:LUNA, SHERRILYN (RPT)
Entity Type:Individual
Prefix:
First Name:SHERRILYN
Middle Name:
Last Name:LUNA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:GLEN GARDNER
Mailing Address - State:NJ
Mailing Address - Zip Code:08826-3010
Mailing Address - Country:US
Mailing Address - Phone:646-393-7368
Mailing Address - Fax:
Practice Address - Street 1:1028 EAST 179 STREET
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460
Practice Address - Country:US
Practice Address - Phone:718-842-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0215972251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty