Provider Demographics
NPI:1013155910
Name:YACKOFF, SHERRY E (LPN)
Entity Type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:E
Last Name:YACKOFF
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:SHERRY
Other - Middle Name:E
Other - Last Name:MOREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:26 PRAIRIE TRAIL
Mailing Address - Street 2:
Mailing Address - City:WEST HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14586-9761
Mailing Address - Country:US
Mailing Address - Phone:585-721-1104
Mailing Address - Fax:
Practice Address - Street 1:26 PRAIRIE TRAIL
Practice Address - Street 2:
Practice Address - City:WEST HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14586-9761
Practice Address - Country:US
Practice Address - Phone:585-721-1104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223074164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse