Provider Demographics
NPI:1306573076
Name:DELONG, SHERRY M
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:M
Last Name:DELONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 SAINT CLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-3053
Mailing Address - Country:US
Mailing Address - Phone:330-385-0700
Mailing Address - Fax:330-386-1010
Practice Address - Street 1:650 SAINT CLAIR AVE
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-3053
Practice Address - Country:US
Practice Address - Phone:330-385-0700
Practice Address - Fax:330-386-1010
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-03
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2570R310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility