Provider Demographics
NPI:1780059279
Name:CARR, SHARRELL AAISHA (LPN)
Entity type:Individual
Prefix:MS
First Name:SHARRELL
Middle Name:AAISHA
Last Name:CARR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:SHARRELL
Other - Middle Name:AAISHA
Other - Last Name:CARR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:94 PLAD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-2600
Mailing Address - Country:US
Mailing Address - Phone:631-889-0684
Mailing Address - Fax:631-730-8199
Practice Address - Street 1:94 PLAD BLVD
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-2600
Practice Address - Country:US
Practice Address - Phone:631-889-0684
Practice Address - Fax:631-730-8199
Is Sole Proprietor?:No
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314827164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse