Provider Demographics
NPI:1427542521
Name:ANDERSON, SHARON ANGELLA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:ANGELLA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2027 STRANG AVE # 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2339
Mailing Address - Country:US
Mailing Address - Phone:347-686-0902
Mailing Address - Fax:
Practice Address - Street 1:2027 STRANG AVE # 2
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2339
Practice Address - Country:US
Practice Address - Phone:347-686-0902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332007164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse