Healthcare Provider Details

I. General information

NPI: 1174008056
Provider Name (Legal Business Name): SHERA WONG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13743 45TH AVE
FLUSHING NY
11355-4048
US

IV. Provider business mailing address

13743 45TH AVE
FLUSHING NY
11355-4048
US

V. Phone/Fax

Practice location:
  • Phone: 929-362-3018
  • Fax: 929-362-3023
Mailing address:
  • Phone: 929-362-3018
  • Fax: 929-362-3023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number745898
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: