Provider Demographics
NPI:1497930622
Name:BENTLEY-SHARPE10, MONICA
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:BENTLEY-SHARPE10
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 1:30 N TERRACE AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-1831
Mailing Address - Country:US
Mailing Address - Phone:917-405-7718
Mailing Address - Fax:
Practice Address - Street 1:30 N TERRACE AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-1831
Practice Address - Country:US
Practice Address - Phone:917-405-7718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY289247164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02925973Medicaid