Healthcare Provider Details

I. General information

NPI: 1871845545
Provider Name (Legal Business Name): SHARESSE WASHINGTON LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2012
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 NEW YORK AVE
DEER PARK NY
11729-2035
US

IV. Provider business mailing address

19 NEW YORK AVE
DEER PARK NY
11729-2035
US

V. Phone/Fax

Practice location:
  • Phone: 516-395-9370
  • Fax:
Mailing address:
  • Phone: 516-395-9370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number311685
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: