Provider Demographics
NPI:1881104768
Name:STEPHENSON, SHARON
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:STEPHENSON
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 1:51 FOSTER AVENUE
Mailing Address - Street 2:NORTH VALLEY STREAM
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580
Mailing Address - Country:US
Mailing Address - Phone:516-996-2176
Mailing Address - Fax:516-285-0267
Practice Address - Street 1:51 FOSTER AVENUE
Practice Address - Street 2:NORTH VALLEY STREAM
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580
Practice Address - Country:US
Practice Address - Phone:516-996-2176
Practice Address - Fax:516-285-0267
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNONEOtherFOR MY JOB SERVICE PROVIDER
NY$$$$$$$$$OtherFOR PROVIDER OF SERVICE (MY JOB)