Provider Demographics
NPI:1093945776
Name:GULLO, SHARON E (PEDIATRIC NURSE PRAC)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:E
Last Name:GULLO
Suffix:
Gender:F
Credentials:PEDIATRIC NURSE PRAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4495 MIDDLE CHESIRE R.
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4887 STATE ROUTE 96A
Practice Address - Street 2:HILLSIDE CHILDREN'S CENTER
Practice Address - City:ROMULUS
Practice Address - State:NY
Practice Address - Zip Code:14541
Practice Address - Country:US
Practice Address - Phone:315-585-3166
Practice Address - Fax:315-585-3061
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381302-1363LP0200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics