Healthcare Provider Details

I. General information

NPI: 1841553005
Provider Name (Legal Business Name): ANDREA SHERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379 MT HOPE RD
MIDDLETOWN NY
10940-7135
US

IV. Provider business mailing address

29 HORIZON HILL DR
POUGHKEEPSIE NY
12603-5513
US

V. Phone/Fax

Practice location:
  • Phone: 845-344-3392
  • Fax: 845-342-2054
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: