Provider Demographics
NPI:1811292279
Name:BEAUVIL, SHERLIE
Entity type:Individual
Prefix:
First Name:SHERLIE
Middle Name:
Last Name:BEAUVIL
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 1:2425 NOSTRAND AVE
Mailing Address - Street 2:APT. 416
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4056
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2425 NOSTRAND AVE
Practice Address - Street 2:APT. 416
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-4056
Practice Address - Country:US
Practice Address - Phone:212-719-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-17
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300517164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse