MEDICARE: DR. SHERRY LOUISE HUMPHREY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	24881801	NY
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	24881801	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	24881801	OTHER	NY	NYS LICENSE

General Provider Information

NPI Number	:	1629226667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHERRY LOUISE HUMPHREY MD

Provider Business Mailing Address
First Line	:	100 W KINGSBRIDGE RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10468-3961
Country	:	US
Telephone Number	:	718-410-1436
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 W KINGSBRIDGE RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10468-3961
Country	:	US
Telephone Number	:	718-410-1436
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2008
Last Update Date	:	01/15/2015

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