Healthcare Provider Details

I. General information

NPI: 1598583569
Provider Name (Legal Business Name): SHARICE BURKS PERSONAL TRAINER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 09/30/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 616 SALEM AVE
ELIZABETH NJ
07208
US

IV. Provider business mailing address

80 ROXBURY ST APT 2C
STATEN ISLAND NY
10303-1915
US

V. Phone/Fax

Practice location:
  • Phone: 347-254-8232
  • Fax:
Mailing address:
  • Phone: 347-254-8232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: