Healthcare Provider Details

I. General information

NPI: 1588737357
Provider Name (Legal Business Name): CATHY L. SHEREDOS-FUNFGELD P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 GARDNER AVE
JERICHO NY
11753-2463
US

IV. Provider business mailing address

216 GARDNER AVE
JERICHO NY
11753-2463
US

V. Phone/Fax

Practice location:
  • Phone: 516-938-3622
  • Fax: 212-563-0605
Mailing address:
  • Phone: 516-938-3622
  • Fax: 212-563-0605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number007659
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: