Healthcare Provider Details

I. General information

NPI: 1720185275
Provider Name (Legal Business Name): SHERRY S HERDMAN M.S, FNP, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 CHURCH ST.
ALFRED NY
14802
US

IV. Provider business mailing address

4707 LILLY RD. PO BOX 38
ANGELICA NY
14709-0038
US

V. Phone/Fax

Practice location:
  • Phone: 607-587-8143
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF331046-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: