Healthcare Provider Details

I. General information

NPI: 1871831768
Provider Name (Legal Business Name): MS. SHARRON HOPE HEPBURN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2013
Last Update Date: 01/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CLIFFORD ST
LYNBROOK NY
11563-1914
US

IV. Provider business mailing address

2 CLIFFORD ST
LYNBROOK NY
11563-1914
US

V. Phone/Fax

Practice location:
  • Phone: 917-975-3118
  • Fax:
Mailing address:
  • Phone: 917-975-3118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number229471-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: