Healthcare Provider Details

I. General information

NPI: 1982638490
Provider Name (Legal Business Name): MICHAEL SHERWOOD CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 HARRIS-BUSHVILLE ROAD CATSKILL REGIONAL MEDICAL CENTER
HARRIS NY
12742
US

IV. Provider business mailing address

100 ROUTE 59 SUITE 105
SUFFERN NY
10901-4927
US

V. Phone/Fax

Practice location:
  • Phone: 845-794-3300
  • Fax: 845-790-2675
Mailing address:
  • Phone: 845-357-5775
  • Fax: 845-357-5777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number326166-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: