Provider Demographics
NPI:1366288797
Name:PENDLETON, SHERRILL JAVON (LPN)
Entity type:Individual
Prefix:
First Name:SHERRILL
Middle Name:JAVON
Last Name:PENDLETON
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 1:118 MASTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:MASTIC
Mailing Address - State:NY
Mailing Address - Zip Code:11950-3522
Mailing Address - Country:US
Mailing Address - Phone:631-384-7326
Mailing Address - Fax:
Practice Address - Street 1:118 MASTIC BLVD
Practice Address - Street 2:
Practice Address - City:MASTIC
Practice Address - State:NY
Practice Address - Zip Code:11950-3522
Practice Address - Country:US
Practice Address - Phone:631-384-7326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-04
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY350322164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty