Provider Demographics
NPI:1215975024
Name:LABELSON, SHARA FAWN (DPT)
Entity type:Individual
Prefix:
First Name:SHARA
Middle Name:FAWN
Last Name:LABELSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 RENAISSANCE SQ APT 9B
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-3043
Mailing Address - Country:US
Mailing Address - Phone:917-741-9742
Mailing Address - Fax:
Practice Address - Street 1:149 E 62ND ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7630
Practice Address - Country:US
Practice Address - Phone:646-429-9673
Practice Address - Fax:646-429-8573
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21201174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQP6891Medicare ID - Type Unspecified