Provider Demographics
NPI:1831239151
Name:SHERMAN, DEBORAH KAY (LPN)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:KAY
Last Name:SHERMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1381 ROUTE 44
Mailing Address - Street 2:POBOX 928
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12569-7828
Mailing Address - Country:US
Mailing Address - Phone:845-635-9769
Mailing Address - Fax:845-635-8749
Practice Address - Street 1:1381 ROUTE 44
Practice Address - Street 2:
Practice Address - City:PLEASANT VALLEY
Practice Address - State:NY
Practice Address - Zip Code:12569-7828
Practice Address - Country:US
Practice Address - Phone:845-635-9769
Practice Address - Fax:845-635-8749
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159162-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01812317Medicaid