Healthcare Provider Details

I. General information

NPI: 1154323194
Provider Name (Legal Business Name): SHARI L NICHOLS DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 12/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 PENNSYLVANIA AVE SUITE 200
BINGHAMTON NY
13903-1651
US

IV. Provider business mailing address

346 GRAND AVE
JOHNSON CITY NY
13790
US

V. Phone/Fax

Practice location:
  • Phone: 607-772-8772
  • Fax: 607-772-8796
Mailing address:
  • Phone: 607-729-8156
  • Fax: 607-729-3982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN005456
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: