Provider Demographics
NPI:1841776317
Name:SASSOUNI, SHARONA (DOCTOR OF OPTOMETRY)
Entity Type:Individual
Prefix:DR
First Name:SHARONA
Middle Name:
Last Name:SASSOUNI
Suffix:
Gender:F
Credentials:DOCTOR OF OPTOMETRY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 VILLA ST
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1950
Mailing Address - Country:US
Mailing Address - Phone:516-582-2329
Mailing Address - Fax:
Practice Address - Street 1:360 WILLIS AVE
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2322
Practice Address - Country:US
Practice Address - Phone:516-568-5930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008761152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist