Provider Demographics
NPI:1750897559
Name:SMITH, SHARLENE
Entity type:Individual
Prefix:MS
First Name:SHARLENE
Middle Name:
Last Name:SMITH
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 1:1995 MURRAY HILL ST
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-2100
Mailing Address - Country:US
Mailing Address - Phone:516-424-8187
Mailing Address - Fax:
Practice Address - Street 1:1995 MURRAY HILL ST
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-2100
Practice Address - Country:US
Practice Address - Phone:516-424-8187
Practice Address - Fax:516-424-8187
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-17
Last Update Date:2017-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330976-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse