Healthcare Provider Details

I. General information

NPI: 1780834671
Provider Name (Legal Business Name): MISS SHARON AFFLICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHARON AFFLICK RD

II. Dates (important events)

Enumeration Date: 09/26/2008
Last Update Date: 10/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

959 E 108TH ST APR 2 - D
BROOKLYN NY
11236-3052
US

IV. Provider business mailing address

959 E 108TH ST APR 2 - D
BROOKLYN NY
11236-3052
US

V. Phone/Fax

Practice location:
  • Phone: 718-927-4338
  • Fax: 718-927-4338
Mailing address:
  • Phone: 718-927-4338
  • Fax: 718-927-4338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number004274-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: