Healthcare Provider Details

I. General information

NPI: 1124302468
Provider Name (Legal Business Name): SHERRI L GILLAM CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2011
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 CENTRE ST PH 120
NEW YORK NY
10013-4559
US

IV. Provider business mailing address

139 CENTRE ST PH 120
NEW YORK NY
10013-4559
US

V. Phone/Fax

Practice location:
  • Phone: 888-731-8994
  • Fax: 833-775-1861
Mailing address:
  • Phone: 888-731-8994
  • Fax: 833-775-1861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN.CNP.019684
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: