Provider Demographics
NPI:1386803468
Name:GOLDBERG, SHARON IDA (FNP-BC, CWOCN)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:IDA
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:FNP-BC, CWOCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 CEDAR CLIFF RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-4708
Mailing Address - Country:US
Mailing Address - Phone:845-782-4355
Mailing Address - Fax:845-782-0992
Practice Address - Street 1:278 CEDAR CLIFF RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-4708
Practice Address - Country:US
Practice Address - Phone:845-782-4355
Practice Address - Fax:845-782-0992
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333866-1363LF0000X
NY297819163WW0000X, 163WE0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WE0900XNursing Service ProvidersRegistered NurseEnterostomal Therapy