Provider Demographics
NPI:1356968267
Name:COOMBS-ROSE, SHARON ANN
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:ANN
Last Name:COOMBS-ROSE
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 1:772 VERMONT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-7009
Mailing Address - Country:US
Mailing Address - Phone:718-272-2363
Mailing Address - Fax:718-272-0406
Practice Address - Street 1:1404 BROOKLYN AVE
Practice Address - Street 2:COMMUNITY CENTER
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-1805
Practice Address - Country:US
Practice Address - Phone:718-282-2732
Practice Address - Fax:718-282-7231
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator