Provider Demographics
NPI:1457601403
Name:REILL, SHERRY (ANP-C)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:REILL
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 NORTHERN BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3008
Mailing Address - Country:US
Mailing Address - Phone:516-732-1422
Mailing Address - Fax:
Practice Address - Street 1:1615 NORTHERN BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3008
Practice Address - Country:US
Practice Address - Phone:516-732-1422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305986363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health