Provider Demographics
NPI:1356644546
Name:PETERS, SHARON ANNE (RN)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:ANNE
Last Name:PETERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 RAM CT
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-1430
Mailing Address - Country:US
Mailing Address - Phone:631-654-0476
Mailing Address - Fax:
Practice Address - Street 1:6 RAM CT
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1430
Practice Address - Country:US
Practice Address - Phone:631-654-0476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308789-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse