Provider Demographics
NPI:1275053043
Name:LONG, SHARON BETH (RN)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:BETH
Last Name:LONG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Mailing Address - Street 1:1506 OVERING ST APT 1B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-3141
Mailing Address - Country:US
Mailing Address - Phone:1718-823-5468
Mailing Address - Fax:
Practice Address - Street 1:1500 WATERS PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2723
Practice Address - Country:US
Practice Address - Phone:718-931-0600
Practice Address - Fax:718-823-5468
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-22
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY445976-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse