Healthcare Provider Details

I. General information

NPI: 1780843516
Provider Name (Legal Business Name): SHARON ELIZABETH CELESTINE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 E 52ND ST C-4
BROOKLYN NY
11203-4543
US

IV. Provider business mailing address

229 W LAKE CT # C-4
SLIDELL LA
70461-5646
US

V. Phone/Fax

Practice location:
  • Phone: 646-298-8142
  • Fax:
Mailing address:
  • Phone: 504-777-1020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number211984
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number211984
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number292601-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: