Provider Demographics
NPI:1780834671
Name:AFFLICK, SHARON
Entity Type:Individual
Prefix:MISS
First Name:SHARON
Middle Name:
Last Name:AFFLICK
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SHARON
Other - Middle Name:
Other - Last Name:AFFLICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:959 E 108TH ST
Mailing Address - Street 2:APR 2 - D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3052
Mailing Address - Country:US
Mailing Address - Phone:718-927-4338
Mailing Address - Fax:718-927-4338
Practice Address - Street 1:959 E 108TH ST
Practice Address - Street 2:APR 2 - D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3052
Practice Address - Country:US
Practice Address - Phone:718-927-4338
Practice Address - Fax:718-927-4338
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004274-1133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric