Healthcare Provider Details

I. General information

NPI: 1972491876
Provider Name (Legal Business Name): KENITRA LACHELLE SHERMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 NEW HARWINTON RD
TORRINGTON CT
06790-5845
US

IV. Provider business mailing address

943 BUNKER HILL AVE
WATERBURY CT
06708-1503
US

V. Phone/Fax

Practice location:
  • Phone: 475-263-2946
  • Fax:
Mailing address:
  • Phone: 475-263-2946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number014974
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: