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General NPI Number Information
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NPI Number | 1720340607
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Entity Type | Individual
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Provider Name | MS. SHERNICE JENELL BLACKMAN
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Gender | Female
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Dates
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Enumeration Date | 06/15/2012
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Last Update Date | 06/15/2012
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Provider Practice Location Address
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Address Line | 2 ROOSEVELT AVE SUITE 300
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City | SYOSSET
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State | NY
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Zip | 11791-3064
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Country | US
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Telephone | 516-496-4460
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Fax |
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Provider Business Mailing Address
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Address Line | 11321 200TH ST
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City | SAINT ALBANS
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State | NY
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Zip | 11412-2526
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Country | US
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Telephone | 718-464-1809
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | NY
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