Provider Demographics
NPI:1942732045
Name:MADERA, SHARLINE (MD, PHD)
Entity Type:Individual
Prefix:
First Name:SHARLINE
Middle Name:
Last Name:MADERA
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 YORK AVE
Mailing Address - Street 2:APT 103
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6307
Mailing Address - Country:US
Mailing Address - Phone:646-228-0099
Mailing Address - Fax:
Practice Address - Street 1:1230 YORK AVE
Practice Address - Street 2:APT 103
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6307
Practice Address - Country:US
Practice Address - Phone:646-228-0099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program