Provider Demographics
NPI:1699106484
Name:ESTEBAN-ELIE, SHERI ELIZABETH (PHD)
Entity type:Individual
Prefix:
First Name:SHERI
Middle Name:ELIZABETH
Last Name:ESTEBAN-ELIE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SHERI
Other - Middle Name:ELIZABETH
Other - Last Name:ESTEBAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:231 MAIN ST LBBY
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-1548
Mailing Address - Country:US
Mailing Address - Phone:607-205-1394
Mailing Address - Fax:
Practice Address - Street 1:231 MAIN ST LBBY
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-1548
Practice Address - Country:US
Practice Address - Phone:607-205-1394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-05
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016498103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03789044Medicaid