Provider Demographics
NPI:1104896570
Name:SHERON, MOLLY ANN (WHNP/CNMW)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:ANN
Last Name:SHERON
Suffix:
Gender:F
Credentials:WHNP/CNMW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 TRANSIT RD
Mailing Address - Street 2:STE 4
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-2606
Mailing Address - Country:US
Mailing Address - Phone:716-810-9718
Mailing Address - Fax:716-439-4479
Practice Address - Street 1:6161 TRANSIT RD
Practice Address - Street 2:STE 4
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-2606
Practice Address - Country:US
Practice Address - Phone:716-810-9718
Practice Address - Fax:716-439-4479
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000974367A00000X
NYF420584363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02490980Medicaid
NY02490980Medicaid
NYRA0062Medicare ID - Type Unspecified