Basic Information
| Provider Information | |||||||||
| NPI: | 1386245033 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABBOTT | ||||||||
| FirstName: | SHERYL | ||||||||
| MiddleName: | LYNN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25400 STEWART DR | ||||||||
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| City: | CARTHAGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136197501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7632264538 | ||||||||
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| Practice Location | |||||||||
| Address1: | 830 WASHINGTON ST | ||||||||
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| City: | WATERTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136014099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157854000 | ||||||||
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| ProviderEnumerationDate: | 11/07/2020 | ||||||||
| LastUpdateDate: | 11/07/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.