Provider Demographics
NPI:1083967921
Name:MAGNO, SHARON B
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:B
Last Name:MAGNO
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 1:5449 83RD ST
Mailing Address - Street 2:APT#1
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4735
Mailing Address - Country:US
Mailing Address - Phone:973-979-1381
Mailing Address - Fax:
Practice Address - Street 1:4111 18TH AVE
Practice Address - Street 2:SUITE#12
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-5894
Practice Address - Country:US
Practice Address - Phone:718-684-2390
Practice Address - Fax:718-684-2393
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031877225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist