Provider Demographics
NPI:1356581045
Name:BRANCH, SHAREN
Entity type:Individual
Prefix:
First Name:SHAREN
Middle Name:
Last Name:BRANCH
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 1:1191 ROUTE 9W
Mailing Address - Street 2:SUITE C2 & C3
Mailing Address - City:MARLBORO
Mailing Address - State:NY
Mailing Address - Zip Code:12542-5421
Mailing Address - Country:US
Mailing Address - Phone:845-236-7838
Mailing Address - Fax:877-254-0888
Practice Address - Street 1:1191 ROUTE 9W
Practice Address - Street 2:SUITE C2 & C3
Practice Address - City:MARLBORO
Practice Address - State:NY
Practice Address - Zip Code:12542-5421
Practice Address - Country:US
Practice Address - Phone:845-236-7838
Practice Address - Fax:877-254-0888
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor