Healthcare Provider Details

I. General information

NPI: 1235816943
Provider Name (Legal Business Name): DANIELLE SHERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE BLADEK

II. Dates (important events)

Enumeration Date: 07/04/2023
Last Update Date: 07/04/2023
Certification Date: 07/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 WHITLOW ST
NEW BEDFORD MA
02740-4644
US

IV. Provider business mailing address

76 WHITLOW ST
NEW BEDFORD MA
02740-4644
US

V. Phone/Fax

Practice location:
  • Phone: 774-218-4941
  • Fax:
Mailing address:
  • Phone: 774-218-4941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN2331627
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN2331627
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: