MEDICARE: SHERELLE DODSON FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	348586	NY

General Provider Information

NPI Number	:	1144949553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERELLE DODSON FNP

Provider Business Mailing Address
First Line	:	2715 30TH AVE
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11102-2445
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2715 30TH AVE
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11102-2445
Country	:	US
Telephone Number	:	718-502-3903
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2022
Last Update Date	:	06/30/2023

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