Provider Demographics
NPI:1962938621
Name:RUIZ, SHARIS
Entity type:Individual
Prefix:
First Name:SHARIS
Middle Name:
Last Name:RUIZ
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:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:10925-0460
Mailing Address - Country:US
Mailing Address - Phone:845-476-0315
Mailing Address - Fax:
Practice Address - Street 1:54 LAKE DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD LAKE
Practice Address - State:NY
Practice Address - Zip Code:10925-2713
Practice Address - Country:US
Practice Address - Phone:845-476-0315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program