Provider Demographics
NPI:1528150752
Name:TATELMAN, SHERYL SUE (PHD)
Entity type:Individual
Prefix:DR
First Name:SHERYL
Middle Name:SUE
Last Name:TATELMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 PITTSFORD VICTOR RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-3800
Mailing Address - Country:US
Mailing Address - Phone:585-586-6390
Mailing Address - Fax:585-586-6390
Practice Address - Street 1:1151 PITTSFORD VICTOR RD
Practice Address - Street 2:SUITE 120
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-3800
Practice Address - Country:US
Practice Address - Phone:585-586-6390
Practice Address - Fax:585-586-6390
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0140321103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY111863F6OtherPREFERRED CARE
NYP030014032OtherBLUE CROSS BLUE SHIELD
NY7336356OtherAETNA
NYP010014032OtherBLUE CHOICE
NYRA2291Medicare ID - Type Unspecified
NY7336356OtherAETNA