Provider Demographics
NPI:1720482078
Name:SERR, SHIRLEY JEAN
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:JEAN
Last Name:SERR
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 1:525 RIVERLEIGH AVE
Mailing Address - Street 2:LOT M8
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-3609
Mailing Address - Country:US
Mailing Address - Phone:631-775-6749
Mailing Address - Fax:
Practice Address - Street 1:525 RIVERLEIGH AVE
Practice Address - Street 2:LOT M8
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-3609
Practice Address - Country:US
Practice Address - Phone:631-775-6749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY092428021164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse