Provider Demographics
NPI:1942296439
Name:PALMER, SHEREEN E (MD)
Entity type:Individual
Prefix:
First Name:SHEREEN
Middle Name:E
Last Name:PALMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5402 DAYAN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LOWVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13367-1117
Mailing Address - Country:US
Mailing Address - Phone:315-376-5558
Mailing Address - Fax:315-376-5587
Practice Address - Street 1:5402 DAYAN ST STE 100
Practice Address - Street 2:
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-1117
Practice Address - Country:US
Practice Address - Phone:315-376-5558
Practice Address - Fax:315-376-5587
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1866671208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02365988Medicaid
AA1500OtherMEDICARE GROUP ID
NY02365988Medicaid
NYRA2677Medicare PIN