Healthcare Provider Details

I. General information

NPI: 1700795556
Provider Name (Legal Business Name): SB ADULT HEALTH NURSE PRACTITIONER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17561 HILLSIDE AVE
JAMAICA NY
11432-5774
US

IV. Provider business mailing address

17561 HILLSIDE AVE STE 202
JAMAICA NY
11432-5771
US

V. Phone/Fax

Practice location:
  • Phone: 516-744-2945
  • Fax:
Mailing address:
  • Phone: 516-744-2945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHERRILLE L BETHUNE
Title or Position: OWNER
Credential: NP
Phone: 516-744-2945