Provider Demographics
NPI:1518031301
Name:RAFALOFF, SHARON M (DPM)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:M
Last Name:RAFALOFF
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2335 BELL BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-2038
Mailing Address - Country:US
Mailing Address - Phone:718-224-2424
Mailing Address - Fax:718-224-2425
Practice Address - Street 1:2335 BELL BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-2038
Practice Address - Country:US
Practice Address - Phone:718-224-2424
Practice Address - Fax:718-224-2425
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004297213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT97969Medicare UPIN
NY0844470001Medicare NSC
NY38333Medicare ID - Type UnspecifiedPROVIDER #