Provider Demographics
NPI:1023430220
Name:GAINES, SHERYL MARCUS (MA-CCC/SLP)
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:MARCUS
Last Name:GAINES
Suffix:
Gender:F
Credentials:MA-CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 KENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2212
Mailing Address - Country:US
Mailing Address - Phone:201-568-0487
Mailing Address - Fax:
Practice Address - Street 1:34 KENWOOD RD
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-2212
Practice Address - Country:US
Practice Address - Phone:201-568-0487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00086100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist