Provider Demographics
NPI:1396083044
Name:SCHAEFER, SHERRY LEE
Entity type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:LEE
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:LEE
Other - Last Name:LODICE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:109 SAWMILL DR
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-1037
Mailing Address - Country:US
Mailing Address - Phone:585-385-3667
Mailing Address - Fax:212-553-7366
Practice Address - Street 1:109 SAWMILL DR
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-1037
Practice Address - Country:US
Practice Address - Phone:585-385-3667
Practice Address - Fax:212-553-7366
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21SC1205808174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
21SC1205808OtherAPPEARANCE ENHANCEMENT BUSINESS LICENSE