Provider Demographics
NPI:1790100238
Name:RUSSO, SHERRI (RN)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:
Last Name:RUSSO
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 1:21 MIDLINE RD
Mailing Address - Street 2:#2
Mailing Address - City:SLATERVILLE SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:14881-9401
Mailing Address - Country:US
Mailing Address - Phone:607-229-4110
Mailing Address - Fax:
Practice Address - Street 1:21 MIDLINE RD
Practice Address - Street 2:#2
Practice Address - City:SLATERVILLE SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:14881-9401
Practice Address - Country:US
Practice Address - Phone:607-229-4110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY632944-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse