Healthcare Provider Details

I. General information

NPI: 1215850359
Provider Name (Legal Business Name): JARED SHERWOOD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 WESTSIDE DR
ROCHESTER NY
14624-1933
US

IV. Provider business mailing address

454 MONTVALE LN
ROCHESTER NY
14626-5214
US

V. Phone/Fax

Practice location:
  • Phone: 585-594-6568
  • Fax:
Mailing address:
  • Phone: 585-775-6526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number005127
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: