Healthcare Provider Details

I. General information

NPI: 1114347044
Provider Name (Legal Business Name): SHARESA NICOLE BALDWIN MS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2014
Last Update Date: 04/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 E 21ST ST APT 3B
BROOKLYN NY
11226-1860
US

IV. Provider business mailing address

55 E 21ST ST APT 3B
BROOKLYN NY
11226-1860
US

V. Phone/Fax

Practice location:
  • Phone: 917-371-7637
  • Fax:
Mailing address:
  • Phone: 917-371-7637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0025071
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: