Provider Demographics
NPI:1154420230
Name:SCHERBA-GERMAIN, ELAINE MARY
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:MARY
Last Name:SCHERBA-GERMAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4898 ROYAL CRAB AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-9310
Mailing Address - Country:US
Mailing Address - Phone:315-430-7586
Mailing Address - Fax:315-498-9129
Practice Address - Street 1:4898 ROYAL CRAB AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215-9310
Practice Address - Country:US
Practice Address - Phone:315-430-7586
Practice Address - Fax:315-498-9129
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY321851163WP0808X
NY301483363LA2200X
NY400816363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02994838OtherOCMS GRP MCD
1235184235OtherOCMS GRP NPI
BA1047OtherOCMS GRP MCR