Provider Demographics
NPI:1629150875
Name:RAKE, SHARI JOY (SHARI J RAKE, RN CNM)
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:JOY
Last Name:RAKE
Suffix:
Gender:F
Credentials:SHARI J RAKE, RN CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 JESSUP RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-2529
Mailing Address - Country:US
Mailing Address - Phone:845-988-5654
Mailing Address - Fax:
Practice Address - Street 1:974 ROUTE 45 STE 1000
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3568
Practice Address - Country:US
Practice Address - Phone:845-354-1113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME00041100367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05056079Medicaid
NYA400191181OtherMEDICARE
NY000597OtherNY LICENSE