Provider Demographics
NPI:1720185275
Name:HERDMAN, SHERRY S (MS, FNP, CDE)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:S
Last Name:HERDMAN
Suffix:
Gender:F
Credentials:MS, FNP, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4707 LILLY RD.
Mailing Address - Street 2:PO BOX 38
Mailing Address - City:ANGELICA
Mailing Address - State:NY
Mailing Address - Zip Code:14709-0038
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:28 CHURCH ST.
Practice Address - Street 2:
Practice Address - City:ALFRED
Practice Address - State:NY
Practice Address - Zip Code:14802
Practice Address - Country:US
Practice Address - Phone:607-587-8143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331046-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily