Healthcare Provider Details

I. General information

NPI: 1376263277
Provider Name (Legal Business Name): SHERIDIAN CORTESMENDEZ LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 GLEN COVE AVE
GLEN COVE NY
11542-3438
US

IV. Provider business mailing address

14 FOREST AVE
GLEN COVE NY
11542-2106
US

V. Phone/Fax

Practice location:
  • Phone: 516-646-2388
  • Fax: 516-759-5259
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number117622-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: