Provider Demographics
NPI:1700856689
Name:TOMACK, SHERYL R (MD)
Entity Type:Individual
Prefix:DR
First Name:SHERYL
Middle Name:R
Last Name:TOMACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:85E MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-5984
Mailing Address - Country:US
Mailing Address - Phone:516-596-3030
Mailing Address - Fax:516-596-3003
Practice Address - Street 1:85 E MERRICK RD
Practice Address - Street 2:STE 1
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5984
Practice Address - Country:US
Practice Address - Phone:516-596-3030
Practice Address - Fax:516-596-3003
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156322207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY89D381OtherMEDICARE ID
NYA64669Medicare UPIN