Provider Demographics
NPI:1659413516
Name:JOHN, SHARI E (MA CCC-A)
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:E
Last Name:JOHN
Suffix:
Gender:F
Credentials:MA CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 NORTEMA CT
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2031
Mailing Address - Country:US
Mailing Address - Phone:516-270-3583
Mailing Address - Fax:
Practice Address - Street 1:74-20 25TH AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHT
Practice Address - State:NY
Practice Address - Zip Code:11370-1428
Practice Address - Country:US
Practice Address - Phone:718-350-3171
Practice Address - Fax:718-458-1367
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00667758Medicaid