1205983301 NPI number — SHERRI LANDES PH.D.

Table of content: SHERRI LANDES PH.D. (NPI 1205983301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205983301 NPI number — SHERRI LANDES PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANDES
Provider First Name:
SHERRI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205983301
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 BUSTLETON PIKE
Provider Second Line Business Mailing Address:
SUITE 4B
Provider Business Mailing Address City Name:
FEASTERVILLE TREVOSE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19053-4118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-364-0344
Provider Business Mailing Address Fax Number:
215-364-3931

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 BUSTLETON PK
Provider Second Line Business Practice Location Address:
SUITE 4B
Provider Business Practice Location Address City Name:
FEASTERVILLE TREVOSE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19053-4118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-364-0344
Provider Business Practice Location Address Fax Number:
215-364-3931
Provider Enumeration Date:
01/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PS003801L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 167033 . This is a "VALUE OPTIONS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 73890 . This is a "BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com