Healthcare Provider Details

I. General information

NPI: 1063663888
Provider Name (Legal Business Name): SHARON MCCLURE MHA, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2008
Last Update Date: 10/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2534 STEINWAY ST
ASTORIA NY
11103-3702
US

IV. Provider business mailing address

11415 165TH ST
JAMAICA NY
11434-1211
US

V. Phone/Fax

Practice location:
  • Phone: 718-777-5243
  • Fax: 718-777-5250
Mailing address:
  • Phone: 718-523-7922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number004606-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: