Provider Demographics
NPI:1205983301
Name:LANDES, SHERRI (PHD)
Entity type:Individual
Prefix:
First Name:SHERRI
Middle Name:
Last Name:LANDES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 BUSTLETON PIKE
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-4118
Mailing Address - Country:US
Mailing Address - Phone:215-364-0344
Mailing Address - Fax:215-364-3931
Practice Address - Street 1:1200 BUSTLETON PK
Practice Address - Street 2:SUITE 4B
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-4118
Practice Address - Country:US
Practice Address - Phone:215-364-0344
Practice Address - Fax:215-364-3931
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003801L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA167033OtherVALUE OPTIONS
PA73890OtherBLUE CROSS
PA167033OtherVALUE OPTIONS