Healthcare Provider Details

I. General information

NPI: 1922647452
Provider Name (Legal Business Name): SHERRY LYNN PHARO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2020
Last Update Date: 01/01/2020
Certification Date: 01/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 W JIMMIE LEEDS RD
GALLOWAY NJ
08205-9438
US

IV. Provider business mailing address

213 COUNTRY CLUB BLVD
LITTLE EGG HARBOR TWP NJ
08087-1888
US

V. Phone/Fax

Practice location:
  • Phone: 609-404-0056
  • Fax: 609-404-0506
Mailing address:
  • Phone: 609-618-8619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ00927500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: