Healthcare Provider Details

I. General information

NPI: 1164342853
Provider Name (Legal Business Name): SHEREIKA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7905 MAIN RD
MATTITUCK NY
11952-1693
US

IV. Provider business mailing address

440 MARCY AVE
RIVERHEAD NY
11901-2911
US

V. Phone/Fax

Practice location:
  • Phone: 631-298-2030
  • Fax:
Mailing address:
  • Phone: 901-474-9076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF358784
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: