Healthcare Provider Details

I. General information

NPI: 1174438931
Provider Name (Legal Business Name): LISA SHERMAN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 W 106TH ST APT 4A
NEW YORK NY
10025-3878
US

IV. Provider business mailing address

58 W 106TH ST APT 4A
NEW YORK NY
10025-3878
US

V. Phone/Fax

Practice location:
  • Phone: 917-494-7647
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number032909
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: