Healthcare Provider Details

I. General information

NPI: 1942128749
Provider Name (Legal Business Name): SHARMA-SHANE FANTANA SERGEANT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2927 DRIFTWOOD LN
VINELAND NJ
08361-6739
US

IV. Provider business mailing address

2927 DRIFTWOOD LN
VINELAND NJ
08361-6739
US

V. Phone/Fax

Practice location:
  • Phone: 856-200-9574
  • Fax:
Mailing address:
  • Phone: 856-200-9574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15591100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: