Provider Demographics
NPI:1598583569
Name:BURKS, SHARICE (PERSONAL TRAINER)
Entity type:Individual
Prefix:MR
First Name:SHARICE
Middle Name:
Last Name:BURKS
Suffix:
Gender:M
Credentials:PERSONAL TRAINER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 ROXBURY ST APT 2C
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-1915
Mailing Address - Country:US
Mailing Address - Phone:347-254-8232
Mailing Address - Fax:
Practice Address - Street 1:602 616 SALEM AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208
Practice Address - Country:US
Practice Address - Phone:347-254-8232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education