Provider Demographics
NPI:1962572768
Name:HOEY, SHARON (PA)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:HOEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 BLUE POINT RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-1839
Mailing Address - Country:US
Mailing Address - Phone:631-732-5999
Mailing Address - Fax:631-696-1132
Practice Address - Street 1:465 BLUE POINT RD
Practice Address - Street 2:SUITE D
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-1839
Practice Address - Country:US
Practice Address - Phone:631-732-5999
Practice Address - Fax:631-696-1132
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006998363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NY0033S231Medicare ID - Type Unspecified