Provider Demographics
NPI:1336136902
Name:SHARI'S SHOES LLC
Entity Type:Organization
Organization Name:SHARI'S SHOES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED PEDORTHIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:NUERAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:203-753-7463
Mailing Address - Street 1:1420 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06704-2713
Mailing Address - Country:US
Mailing Address - Phone:203-753-7463
Mailing Address - Fax:203-753-7463
Practice Address - Street 1:1420 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06704-2713
Practice Address - Country:US
Practice Address - Phone:203-753-7463
Practice Address - Fax:203-753-7463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
9948332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
5434980001Medicare NSC