Provider Demographics
NPI:1467992305
Name:SPIEWAK, SHARONA TIKVAH
Entity Type:Individual
Prefix:
First Name:SHARONA
Middle Name:TIKVAH
Last Name:SPIEWAK
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 1:750 LEFFERTS AVE
Mailing Address - Street 2:APT C6
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-1249
Mailing Address - Country:US
Mailing Address - Phone:917-287-1620
Mailing Address - Fax:
Practice Address - Street 1:750 LEFFERTS AVE
Practice Address - Street 2:APT C6
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1249
Practice Address - Country:US
Practice Address - Phone:917-287-1620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-25
Last Update Date:2017-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0867037174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist