Healthcare Provider Details

I. General information

NPI: 1225482227
Provider Name (Legal Business Name): LOLITA ANGELIQUE SHERMAN-COYLE PSY D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2016
Last Update Date: 04/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 SAINT MARKS PL APT 8M 8M
STATEN ISLAND NY
10301-1650
US

IV. Provider business mailing address

165 SAINT MARKS PL APT 8M 8M
STATEN ISLAND NY
10301-1650
US

V. Phone/Fax

Practice location:
  • Phone: 347-466-4843
  • Fax:
Mailing address:
  • Phone: 347-466-4843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: