Healthcare Provider Details

I. General information

NPI: 1184586588
Provider Name (Legal Business Name): SHERYL JACKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 EASTON AVE
NEW BRUNSWICK NJ
08901-1766
US

IV. Provider business mailing address

11 STURBRIDGE DR E
PISCATAWAY NJ
08854-5142
US

V. Phone/Fax

Practice location:
  • Phone: 732-339-7879
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number25ME00094400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: