Provider Demographics
NPI:1316595564
Name:SHARABY-GLASSER, DANIELLE (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:SHARABY-GLASSER
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:597 BOTHNER ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-3609
Mailing Address - Country:US
Mailing Address - Phone:516-242-3405
Mailing Address - Fax:
Practice Address - Street 1:FRANKLIN K LANE SCHOOL BASED HEALTH CENTER
Practice Address - Street 2:999 JAMAICA AVENUE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208
Practice Address - Country:US
Practice Address - Phone:718-235-1087
Practice Address - Fax:718-235-1291
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY383052363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care