Provider Demographics
NPI:1881833499
Name:JACKSON, SHERRY (MD)
Entity Type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 PARK AVE
Mailing Address - Street 2:2C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1154
Mailing Address - Country:US
Mailing Address - Phone:212-427-3404
Mailing Address - Fax:212-427-3604
Practice Address - Street 1:1095 PARK AVE
Practice Address - Street 2:2C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1154
Practice Address - Country:US
Practice Address - Phone:212-427-3404
Practice Address - Fax:212-427-3604
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181638207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology