Healthcare Provider Details

I. General information

NPI: 1811163728
Provider Name (Legal Business Name): SHARA DENISE MAYBERRY APRN BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 EAST ROOSEVELT STREET CLINICAL SERVICES
PHOENIX AZ
85006
US

IV. Provider business mailing address

2 UNIVERSITY PLZ STE 204
HACKENSACK NJ
07601-6211
US

V. Phone/Fax

Practice location:
  • Phone: 602-506-6660
  • Fax: 602-372-0342
Mailing address:
  • Phone: 551-295-8223
  • Fax: 602-372-0342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP2218
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: