Healthcare Provider Details

I. General information

NPI: 1720381262
Provider Name (Legal Business Name): SHARON ANGELLA GRAHAM-RICHARDS RN.CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2094 PITKIN AVE
BROOKLYN NY
11207-3509
US

IV. Provider business mailing address

60 PAERDEGAT 2ND ST
BROOKLYN NY
11236-4132
US

V. Phone/Fax

Practice location:
  • Phone: 718-240-0495
  • Fax: 718-240-0411
Mailing address:
  • Phone: 718-444-0808
  • Fax: 718-240-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number404331-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: