Provider Demographics
NPI:1366930422
Name:SYRELL, SHEILA M (LPN)
Entity type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:M
Last Name:SYRELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:SHEILA
Other - Middle Name:M
Other - Last Name:MILLIMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:12005 E MAIN ST # 2
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:NY
Mailing Address - Zip Code:14590-1021
Mailing Address - Country:US
Mailing Address - Phone:315-879-0950
Mailing Address - Fax:
Practice Address - Street 1:12005 E MAIN ST # 2
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:NY
Practice Address - Zip Code:14590-1021
Practice Address - Country:US
Practice Address - Phone:315-879-0950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY321378164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse