Provider Demographics
NPI:1538398052
Name:SHARON DE JESUS, NP IN PSYCHIATRY, BC, PLLC
Entity type:Organization
Organization Name:SHARON DE JESUS, NP IN PSYCHIATRY, BC, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:DE JESUS
Authorized Official - Suffix:
Authorized Official - Credentials:MS,NP-BC
Authorized Official - Phone:347-935-3333
Mailing Address - Street 1:3016 31ST ST
Mailing Address - Street 2:MAIN FL
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-1866
Mailing Address - Country:US
Mailing Address - Phone:347-935-3333
Mailing Address - Fax:347-935-3936
Practice Address - Street 1:3016 31ST ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1866
Practice Address - Country:US
Practice Address - Phone:917-557-5741
Practice Address - Fax:347-935-3936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-06
Last Update Date:2011-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY400845251S00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty