Provider Demographics
NPI:1245669886
Name:LEVI-GRYSMAN, SHARONA
Entity type:Individual
Prefix:MRS
First Name:SHARONA
Middle Name:
Last Name:LEVI-GRYSMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHARONA
Other - Middle Name:
Other - Last Name:BINIAMINOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14108 JEWEL AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1618
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14108 JEWEL AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1618
Practice Address - Country:US
Practice Address - Phone:347-358-2431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY675248121174400000X
NY675247121174400000X
NY802953131174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist