Provider Demographics
NPI:1699473710
Name:MAIR, SHARESE S
Entity type:Individual
Prefix:
First Name:SHARESE
Middle Name:S
Last Name:MAIR
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 1:80 MAIDEN LN
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-4811
Mailing Address - Country:US
Mailing Address - Phone:212-683-6700
Mailing Address - Fax:
Practice Address - Street 1:80 MAIDEN LN FL 8
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4783
Practice Address - Country:US
Practice Address - Phone:212-683-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY738451163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse