Healthcare Provider Details

I. General information

NPI: 1710815998
Provider Name (Legal Business Name): SHERILYN LONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

579 W HAYDEN AVE
HAYDEN ID
83835-9726
US

IV. Provider business mailing address

217 CEDAR ST # 80
SANDPOINT ID
83864-1410
US

V. Phone/Fax

Practice location:
  • Phone: 208-714-9542
  • Fax:
Mailing address:
  • Phone: 208-714-9542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMASG-2080
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: