Provider Demographics
NPI:1437558244
Name:ZACHARIAS, SHERIN SHIJO (NP)
Entity Type:Individual
Prefix:MRS
First Name:SHERIN
Middle Name:SHIJO
Last Name:ZACHARIAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SHERIN
Other - Middle Name:
Other - Last Name:JOSEPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:MOSHOLU MEDICAL GROUP
Mailing Address - Street 2:5750 MOSHOLU AVE.
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471
Mailing Address - Country:US
Mailing Address - Phone:718-601-0627
Mailing Address - Fax:718-601-0367
Practice Address - Street 1:MOSHOLU MEDICAL GROUP
Practice Address - Street 2:5750 MOSHOLU AVE.
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471
Practice Address - Country:US
Practice Address - Phone:718-601-0627
Practice Address - Fax:718-601-0367
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306949363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health