Healthcare Provider Details

I. General information

NPI: 1922993666
Provider Name (Legal Business Name): SHARON ROSE NKASHAMA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502B WOODWARD AVE
NEW HAVEN CT
06512-1900
US

IV. Provider business mailing address

502B WOODWARD AVE
NEW HAVEN CT
06512-1900
US

V. Phone/Fax

Practice location:
  • Phone: 401-390-7464
  • Fax:
Mailing address:
  • Phone: 401-390-7464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number14822
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: