Provider Demographics
NPI:1124168539
Name:WATERS, SHERYL JOY (SLP)
Entity type:Individual
Prefix:MRS
First Name:SHERYL
Middle Name:JOY
Last Name:WATERS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MISS
Other - First Name:SHERYL
Other - Middle Name:JOY
Other - Last Name:KUBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:2043 KENNETH RD
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-5508
Mailing Address - Country:US
Mailing Address - Phone:516-868-7888
Mailing Address - Fax:
Practice Address - Street 1:2043 KENNETH RD
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-5508
Practice Address - Country:US
Practice Address - Phone:516-868-7888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008760-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist