Provider Demographics
NPI:1609521129
Name:GARRETT, SHARITA L
Entity Type:Individual
Prefix:
First Name:SHARITA
Middle Name:L
Last Name:GARRETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHARITA
Other - Middle Name:L
Other - Last Name:GARRETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:395 LIVONIA AVE APT 5B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-7236
Mailing Address - Country:US
Mailing Address - Phone:917-640-1128
Mailing Address - Fax:
Practice Address - Street 1:395 LIVONIA AVE APT 5B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-7236
Practice Address - Country:US
Practice Address - Phone:917-640-1128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist