Provider Demographics
NPI:1558601203
Name:TSADIK, SHARON A (PA)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:A
Last Name:TSADIK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 BEACH 9TH ST
Mailing Address - Street 2:APT 6C
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5622
Mailing Address - Country:US
Mailing Address - Phone:516-306-0601
Mailing Address - Fax:
Practice Address - Street 1:146 BEACH 9TH ST
Practice Address - Street 2:APT 6C
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-5622
Practice Address - Country:US
Practice Address - Phone:516-306-0601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-17
Last Update Date:2013-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016305363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant