=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255603759
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHERILYN BATISTA CRNA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2012
-----------------------------------------------------
Last Update Date | 04/27/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6 NORTHFIELD RD
-----------------------------------------------------
City | CORAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11727-3147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-974-9777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 NORTHFIELD RD
-----------------------------------------------------
City | CORAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11727-3147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-974-9777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 647501-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | 123487
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------