MEDICARE: MRS. SHARONA LEVI-GRYSMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	675248121	NY
2	174400000X	Specialist	675247121	NY
3	174400000X	Specialist	802953131	NY

General Provider Information

NPI Number	:	1245669886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHARONA LEVI-GRYSMAN

Provider Business Mailing Address
First Line	:	14108 JEWEL AVE
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11367-1618
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14108 JEWEL AVE
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11367-1618
Country	:	US
Telephone Number	:	347-358-2431
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2013
Last Update Date	:	09/16/2015

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