Provider Demographics
NPI:1376318881
Name:COATES, SHEARA RENEE
Entity Type:Individual
Prefix:
First Name:SHEARA
Middle Name:RENEE
Last Name:COATES
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 1:121 CENTRAL PL APT D205
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050-3846
Mailing Address - Country:US
Mailing Address - Phone:862-218-5390
Mailing Address - Fax:
Practice Address - Street 1:31 UNION AVE APT A
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-3325
Practice Address - Country:US
Practice Address - Phone:862-218-5390
Practice Address - Fax:862-252-7381
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJC60087047959902347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle