Provider Demographics
NPI:1265793061
Name:EVANS-ACOSTA, SHARLENE (RN)
Entity type:Individual
Prefix:
First Name:SHARLENE
Middle Name:
Last Name:EVANS-ACOSTA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 GOODMAN ST S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-3811
Mailing Address - Country:US
Mailing Address - Phone:585-509-3530
Mailing Address - Fax:
Practice Address - Street 1:569 GOODMAN ST S
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-3811
Practice Address - Country:US
Practice Address - Phone:585-509-3530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY477510163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse