Provider Demographics
NPI:1801213459
Name:CHEVALIER, SHERLEY MARIE
Entity Type:Individual
Prefix:
First Name:SHERLEY
Middle Name:MARIE
Last Name:CHEVALIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:SHERLEY
Other - Last Name:CHEVALIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:191 KINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-3521
Mailing Address - Country:US
Mailing Address - Phone:516-502-4926
Mailing Address - Fax:
Practice Address - Street 1:191 KINGSTON AVE
Practice Address - Street 2:
Practice Address - City:SOUTH FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-3521
Practice Address - Country:US
Practice Address - Phone:516-502-4926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY293806-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse