Provider Demographics
NPI:1578509253
Name:BRONNER, SHARON LYNNE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:LYNNE
Last Name:BRONNER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 PARKWAY PL
Mailing Address - Street 2:
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-1824
Mailing Address - Country:US
Mailing Address - Phone:914-841-5966
Mailing Address - Fax:914-736-6776
Practice Address - Street 1:1 PENN PLZ
Practice Address - Street 2:7TH FLOOR SUITE 725
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10119-0002
Practice Address - Country:US
Practice Address - Phone:917-576-4483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY365175-1163W00000X
NYF340484-1363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ10543Medicare UPIN
NY0463G1Medicare ID - Type Unspecified