Provider Demographics
NPI:1780448027
Name:EDELSTEIN, SHERRI LYNN
Entity type:Individual
Prefix:
First Name:SHERRI
Middle Name:LYNN
Last Name:EDELSTEIN
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 1:56187 PERRIS AVE
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-1687
Mailing Address - Country:US
Mailing Address - Phone:442-666-5470
Mailing Address - Fax:
Practice Address - Street 1:56187 PERRIS AVE
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-1687
Practice Address - Country:US
Practice Address - Phone:442-666-5470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA278063164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse