Provider Demographics
NPI:1164767109
Name:HENRY, SHARON ANN (MD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:ANN
Last Name:HENRY
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 1:3551 LAWRENCEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-4715
Mailing Address - Country:US
Mailing Address - Phone:609-252-4153
Mailing Address - Fax:
Practice Address - Street 1:3551 LAWRENCEVILLE RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-4715
Practice Address - Country:US
Practice Address - Phone:609-252-4153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05194800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA05194800OtherMEDICAL LICENSE