Provider Demographics
NPI:1285418186
Name:PETERS, SHARON BEVERLY (LICENSED PRACTICAL N)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:BEVERLY
Last Name:PETERS
Suffix:
Gender:F
Credentials:LICENSED PRACTICAL N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16937 144TH RD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-5929
Mailing Address - Country:US
Mailing Address - Phone:718-978-7221
Mailing Address - Fax:718-978-0032
Practice Address - Street 1:2263 NAMEOKE AVE
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-3015
Practice Address - Country:US
Practice Address - Phone:347-221-8584
Practice Address - Fax:718-978-0032
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309315164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse