Provider Demographics
NPI:1417761099
Name:SHARKEY EUSTACE, TERESA CATHERINE
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:CATHERINE
Last Name:SHARKEY EUSTACE
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 1:6630 HULL AVE
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-1641
Mailing Address - Country:US
Mailing Address - Phone:917-544-1768
Mailing Address - Fax:
Practice Address - Street 1:6630 HULL AVE
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-1641
Practice Address - Country:US
Practice Address - Phone:917-544-1768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029900225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist