Provider Demographics
NPI:1831326628
Name:BULLOCK, SHARON (LPN)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 OAK FOREST DR
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-6148
Mailing Address - Country:US
Mailing Address - Phone:631-591-1061
Mailing Address - Fax:
Practice Address - Street 1:33 OAK FOREST DR
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-6148
Practice Address - Country:US
Practice Address - Phone:631-591-1061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246825164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse