Healthcare Provider Details

I. General information

NPI: 1457289142
Provider Name (Legal Business Name): SHARON DISEBASTIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 TAMARACK CIR
SKILLMAN NJ
08558-2021
US

IV. Provider business mailing address

3 FIELDSTON RD
PRINCETON NJ
08540-6415
US

V. Phone/Fax

Practice location:
  • Phone: 609-359-2266
  • Fax:
Mailing address:
  • Phone: 609-440-1184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00959300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: