Provider Demographics
NPI:1154743870
Name:CAPISANAN, SHERRY
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:CAPISANAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:CAPISANAN
Other - Last Name:RUMBAOA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:104-04 47TH AVE.
Mailing Address - Street 2:APT. 3E
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368
Mailing Address - Country:US
Mailing Address - Phone:347-608-6482
Mailing Address - Fax:
Practice Address - Street 1:29-16 23RD AVE.
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105
Practice Address - Country:US
Practice Address - Phone:347-507-2507
Practice Address - Fax:347-507-2577
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032036225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist