Provider Demographics
NPI:1558620401
Name:SHARPE, SUSAN ELIZABETH
Entity Type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:SHARPE
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 1:1306A HOPEWELL AVE
Mailing Address - Street 2:1306A
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-1367
Mailing Address - Country:US
Mailing Address - Phone:347-869-3318
Mailing Address - Fax:
Practice Address - Street 1:1306A HOPEWELL AVE
Practice Address - Street 2:1306A
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-1367
Practice Address - Country:US
Practice Address - Phone:347-869-3318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-13
Last Update Date:2012-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285298-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse