Provider Demographics
NPI:1558687277
Name:LEE, SHARON (PA-C)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 GRAND AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4934
Mailing Address - Country:US
Mailing Address - Phone:201-541-1111
Mailing Address - Fax:201-541-0777
Practice Address - Street 1:535 GRAND AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4934
Practice Address - Country:US
Practice Address - Phone:201-541-1111
Practice Address - Fax:201-541-0777
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00226400363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant