Provider Demographics
NPI:1750911418
Name:HARVIN, SHERYL E
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:E
Last Name:HARVIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHERELLE
Other - Middle Name:E
Other - Last Name:HARVIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4277 65TH PL
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-5054
Mailing Address - Country:US
Mailing Address - Phone:516-755-7878
Mailing Address - Fax:
Practice Address - Street 1:42-77 65TH PLACE
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377
Practice Address - Country:US
Practice Address - Phone:516-755-7878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty