Provider Demographics
NPI:1225482227
Name:SHERMAN-COYLE, LOLITA ANGELIQUE (PSY D)
Entity type:Individual
Prefix:PROF
First Name:LOLITA
Middle Name:ANGELIQUE
Last Name:SHERMAN-COYLE
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:165 SAINT MARKS PL APT 8M
Mailing Address - Street 2:8M
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-1650
Mailing Address - Country:US
Mailing Address - Phone:347-466-4843
Mailing Address - Fax:
Practice Address - Street 1:165 SAINT MARKS PL APT 8M
Practice Address - Street 2:8M
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-1650
Practice Address - Country:US
Practice Address - Phone:347-466-4843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-16
Last Update Date:2016-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1841386075Medicare UPIN