Healthcare Provider Details

I. General information

NPI: 1134382484
Provider Name (Legal Business Name): SHARON SMITH MCEVOY RN, MA, NP-C,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

847 N BROADWAY SUITE 103
MASSAPEQUA NY
11758-2373
US

IV. Provider business mailing address

847 N BROADWAY SUITE 103
MASSAPEQUA NY
11758-2373
US

V. Phone/Fax

Practice location:
  • Phone: 516-798-0441
  • Fax: 516-798-0445
Mailing address:
  • Phone: 516-798-0441
  • Fax: 516-798-0445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number304915
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: