Healthcare Provider Details

I. General information

NPI: 1114274073
Provider Name (Legal Business Name): SHERRA MONIQUE WATSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2012
Last Update Date: 12/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CARLISLE ST
ROCHESTER NY
14615-2067
US

IV. Provider business mailing address

34 ELMGUARD ST
ROCHESTER NY
14615-2636
US

V. Phone/Fax

Practice location:
  • Phone: 585-413-0533
  • Fax:
Mailing address:
  • Phone: 585-752-7024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number716740
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: