Healthcare Provider Details

I. General information

NPI: 1013162619
Provider Name (Legal Business Name): SHARONE MARIE JACOBS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 10/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 71ST ST SUITE 620
MIAMI BEACH FL
33141-3038
US

IV. Provider business mailing address

222 E 56TH ST APT 5K
NEW YORK NY
10022-3717
US

V. Phone/Fax

Practice location:
  • Phone: 305-866-9951
  • Fax: 877-284-8933
Mailing address:
  • Phone: 917-715-5759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number257815-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number257815
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: