Provider Demographics
NPI:1780843516
Name:CELESTINE, SHARON ELIZABETH (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:ELIZABETH
Last Name:CELESTINE
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 1:229 W LAKE CT # C-4
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5646
Mailing Address - Country:US
Mailing Address - Phone:504-777-1020
Mailing Address - Fax:
Practice Address - Street 1:491 E 52ND ST
Practice Address - Street 2:C-4
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-4543
Practice Address - Country:US
Practice Address - Phone:646-298-8142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA211984163WG0000X, 363LF0000X
NY292601-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily