Healthcare Provider Details

I. General information

NPI: 1164415493
Provider Name (Legal Business Name): SHERRY MARIA RANSOM DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 NORTH COLUMBUS AVE
MT. VERNON NY
10552-2032
US

IV. Provider business mailing address

360 NORTH COLUMBUS AVE SUITE 1
MT. VERNON NY
10552-2332
US

V. Phone/Fax

Practice location:
  • Phone: 914-668-5296
  • Fax: 914-668-5302
Mailing address:
  • Phone: 914-668-5296
  • Fax: 914-668-5302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN004514
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberN004514
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: