Provider Demographics
NPI:1942030739
Name:SHERIFF, ISATA B
Entity type:Individual
Prefix:
First Name:ISATA
Middle Name:B
Last Name:SHERIFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 E CLIFFORD PL
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-7944
Mailing Address - Country:US
Mailing Address - Phone:646-427-6256
Mailing Address - Fax:
Practice Address - Street 1:61 E CLIFFORD PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-7944
Practice Address - Country:US
Practice Address - Phone:646-427-6256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool