Provider Demographics
NPI:1437421914
Name:PACUK, SHARON (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:PACUK
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 DEAN ST
Mailing Address - Street 2:APT. 8
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-2130
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:521 DEAN ST
Practice Address - Street 2:APT. 8
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-2130
Practice Address - Country:US
Practice Address - Phone:917-224-9127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1296502235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist