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General NPI Number Information
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NPI Number | 1457273252
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Entity Type | Individual
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Provider Name | CRYSTAL TIA SHERMAN AGPCNP-BC
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Gender |
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Dates
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Enumeration Date | 07/27/2026
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Last Update Date | 07/27/2026
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Provider Practice Location Address
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Address Line | 3175 COUNTY ROUTE 30 # A
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City | SALEM
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State | NY
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Zip | 12865-4103
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Country | US
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Telephone | 518-223-3986
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Fax |
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Provider Business Mailing Address
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Address Line | 3175 COUNTY ROUTE 30 # A
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City | SALEM
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State | NY
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Zip | 12865-4103
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | F312829-01
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License Number State | NY
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