Provider Demographics
NPI:1447031851
Name:BRANCH, SHERRY BENITA (LPN)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:BENITA
Last Name:BRANCH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MENANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12204-2887
Mailing Address - Country:US
Mailing Address - Phone:518-650-2966
Mailing Address - Fax:518-650-2625
Practice Address - Street 1:444 BROADWAY
Practice Address - Street 2:
Practice Address - City:MENANDS
Practice Address - State:NY
Practice Address - Zip Code:12204-2887
Practice Address - Country:US
Practice Address - Phone:518-650-2966
Practice Address - Fax:518-650-2625
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303900164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse