Provider Demographics
NPI:1134106156
Name:ST. ANGELO, SHARON (APN)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:
Last Name:ST. ANGELO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13A MAIN ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1941
Mailing Address - Country:US
Mailing Address - Phone:973-726-0355
Mailing Address - Fax:973-726-0255
Practice Address - Street 1:13A MAIN ST
Practice Address - Street 2:SUITE 7
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1941
Practice Address - Country:US
Practice Address - Phone:973-726-0355
Practice Address - Fax:973-726-0255
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN07577500363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6722601Medicaid
NJ551380Medicare UPIN
NJ6722601Medicaid