Healthcare Provider Details

I. General information

NPI: 1154420230
Provider Name (Legal Business Name): ELAINE MARY SCHERBA-GERMAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4898 ROYAL CRAB AVE
SYRACUSE NY
13215-9310
US

IV. Provider business mailing address

4898 ROYAL CRAB AVE
SYRACUSE NY
13215-9310
US

V. Phone/Fax

Practice location:
  • Phone: 315-430-7586
  • Fax: 315-498-9129
Mailing address:
  • Phone: 315-430-7586
  • Fax: 315-498-9129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number321851
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number301483
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number400816
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: