Provider Demographics
NPI:1932492113
Name:WEIN, SHARON
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:WEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22657 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11364-3128
Mailing Address - Country:US
Mailing Address - Phone:718-479-7710
Mailing Address - Fax:
Practice Address - Street 1:22657 UNION TPKE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11364-3128
Practice Address - Country:US
Practice Address - Phone:718-479-7710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007176-1133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist