Provider Demographics
NPI:1235418344
Name:BRYAN, SHARON MERLINE
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:MERLINE
Last Name:BRYAN
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:PO BOX 115
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQ
Mailing Address - State:NY
Mailing Address - Zip Code:11010-0115
Mailing Address - Country:US
Mailing Address - Phone:188-850-1105
Mailing Address - Fax:516-355-0122
Practice Address - Street 1:88 CLEMENT AVE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-2704
Practice Address - Country:US
Practice Address - Phone:188-850-1105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-07
Last Update Date:2011-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110228000063251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health