Healthcare Provider Details

I. General information

NPI: 1083761308
Provider Name (Legal Business Name): SHERRIE LEVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 LARK DR
ALBANY NY
12207-1300
US

IV. Provider business mailing address

920 LARK DR
ALBANY NY
12207-1300
US

V. Phone/Fax

Practice location:
  • Phone: 518-453-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number024627
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number023960
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: