Healthcare Provider Details

I. General information

NPI: 1851650725
Provider Name (Legal Business Name): SHERLEY JEUDY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 GRAND CONCOURSE
BRONX NY
10457-7679
US

IV. Provider business mailing address

127 W 111TH ST APT 6A
NEW YORK NY
10026-4213
US

V. Phone/Fax

Practice location:
  • Phone: 718-518-5635
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number354696
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number648232
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: