Healthcare Provider Details

I. General information

NPI: 1225106644
Provider Name (Legal Business Name): SHERI A SHEBAIRO RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 YORK AVE MEMORIAL SLOAN-KETTERING CANCER CENTER
NEW YORK NY
10065-6007
US

IV. Provider business mailing address

4 BROOK LN
GLEN HEAD NY
11545-3136
US

V. Phone/Fax

Practice location:
  • Phone: 212-639-7900
  • Fax:
Mailing address:
  • Phone: 516-987-0889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number011117
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: