Provider Demographics
NPI:1811211162
Name:CHARBONIER, SHEILA MARIE (PA)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:MARIE
Last Name:CHARBONIER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 SHELLEY AVE
Mailing Address - Street 2:
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1405
Mailing Address - Country:US
Mailing Address - Phone:914-761-0780
Mailing Address - Fax:
Practice Address - Street 1:35 SHELLEY AVE
Practice Address - Street 2:CURRENTLY UNEMPLOYED
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1405
Practice Address - Country:US
Practice Address - Phone:914-761-0780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003264-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY003264-1OtherSTATE OF NY
1017648OtherNCCPA