Provider Demographics
NPI:1821395047
Name:KELLER, SHERI
Entity Type:Individual
Prefix:MRS
First Name:SHERI
Middle Name:
Last Name:KELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHERI
Other - Middle Name:
Other - Last Name:GLASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MACCCSLP
Mailing Address - Street 1:62 KRISTIN LN
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-1235
Mailing Address - Country:US
Mailing Address - Phone:631-265-8007
Mailing Address - Fax:631-592-3904
Practice Address - Street 1:525 HALF HOLLOW RD
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5828
Practice Address - Country:US
Practice Address - Phone:631-592-3047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005690235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist