Provider Demographics
NPI:1871836379
Name:MCDONALD, SHERRY (RN)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:MCDONALD
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 1:420 SHERIDAN PLACE
Mailing Address - Street 2:#14
Mailing Address - City:FARIVIEW
Mailing Address - State:NJ
Mailing Address - Zip Code:07022
Mailing Address - Country:US
Mailing Address - Phone:201-941-4314
Mailing Address - Fax:
Practice Address - Street 1:420 SHERIDAN PL
Practice Address - Street 2:#14
Practice Address - City:FAIRVIEW
Practice Address - State:NJ
Practice Address - Zip Code:07022-1936
Practice Address - Country:US
Practice Address - Phone:201-941-4314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5904321164W00000X
NJ26NR14153800164W00000X
NY251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse