Healthcare Provider Details

I. General information

NPI: 1538398052
Provider Name (Legal Business Name): SHARON DE JESUS, NP IN PSYCHIATRY, BC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 01/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3016 31ST ST
ASTORIA NY
11102-1866
US

IV. Provider business mailing address

3016 31ST ST MAIN FL
ASTORIA NY
11102-1866
US

V. Phone/Fax

Practice location:
  • Phone: 917-557-5741
  • Fax: 347-935-3936
Mailing address:
  • Phone: 347-935-3333
  • Fax: 347-935-3936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number400845
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number400845
License Number StateNY

VIII. Authorized Official

Name: SHARON DE JESUS
Title or Position: NURSE PRACTITIONER/OWNER
Credential: MS,NP-BC
Phone: 347-935-3333