Provider Demographics
NPI:1124338538
Name:SCOPINO, SHERRY KAY (LPN)
Entity type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:KAY
Last Name:SCOPINO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-2806
Mailing Address - Country:US
Mailing Address - Phone:845-856-9703
Mailing Address - Fax:845-856-1070
Practice Address - Street 1:9 CENTER ST
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-2806
Practice Address - Country:US
Practice Address - Phone:845-856-9703
Practice Address - Fax:845-856-1070
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY155130-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01133935Medicaid