Provider Demographics
NPI:1902226228
Name:BEASLEY, SHERRI (LPN)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:867 GAFFEY RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12167-2011
Mailing Address - Country:US
Mailing Address - Phone:607-434-4788
Mailing Address - Fax:
Practice Address - Street 1:867 GAFFEY RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:NY
Practice Address - Zip Code:12167-2011
Practice Address - Country:US
Practice Address - Phone:607-434-4788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10 254064164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse