Provider Demographics
NPI:1295778363
Name:CERAVOLO, SHARON M (APN)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:M
Last Name:CERAVOLO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:M
Other - Last Name:MCCARTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:402 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4112
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:849 COOPER ST
Practice Address - Street 2:
Practice Address - City:DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-2571
Practice Address - Country:US
Practice Address - Phone:856-848-6346
Practice Address - Fax:856-848-5734
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN06916000363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
077356Medicare Oscar/Certification