Provider Demographics
NPI:1205951993
Name:CHERNOFF, SHARON REYNOLDS (LPN)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:REYNOLDS
Last Name:CHERNOFF
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 1:701 WEST FIRST STREET
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-3228
Mailing Address - Country:US
Mailing Address - Phone:315-593-8046
Mailing Address - Fax:
Practice Address - Street 1:701 WEST FIRST STREET
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-3228
Practice Address - Country:US
Practice Address - Phone:315-593-8046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069904-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02648204Medicaid