Provider Demographics
NPI:1154623486
Name:SHERRI LANDES PHD PA
Entity type:Organization
Organization Name:SHERRI LANDES PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:215-364-0344
Mailing Address - Street 1:1200 BUSTLETON PIKE
Mailing Address - Street 2:SUITE 4 B
Mailing Address - City:FEASTERVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19053
Mailing Address - Country:US
Mailing Address - Phone:215-364-0344
Mailing Address - Fax:215-364-3931
Practice Address - Street 1:1200 BUSTLETON PIKE
Practice Address - Street 2:SUITE 4 B
Practice Address - City:FEASTERVILLE
Practice Address - State:PA
Practice Address - Zip Code:19053
Practice Address - Country:US
Practice Address - Phone:215-364-0344
Practice Address - Fax:215-364-3931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003801L261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA73890Medicare PIN