Provider Demographics
NPI:1346573680
Name:GORDON, SHERI MARIE
Entity type:Individual
Prefix:
First Name:SHERI
Middle Name:MARIE
Last Name:GORDON
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 1:65 DUBLIN RD
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12832-5004
Mailing Address - Country:US
Mailing Address - Phone:518-642-1719
Mailing Address - Fax:518-642-1719
Practice Address - Street 1:65 DUBLIN RD
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:NY
Practice Address - Zip Code:12832-5004
Practice Address - Country:US
Practice Address - Phone:518-642-1719
Practice Address - Fax:518-642-1719
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294167-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse