Healthcare Provider Details

I. General information

NPI: 1871274274
Provider Name (Legal Business Name): SHARAY T CHAMBERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 2ND ST APT E509
MINEOLA NY
11501-6002
US

IV. Provider business mailing address

199 2ND ST APT E509
MINEOLA NY
11501-6002
US

V. Phone/Fax

Practice location:
  • Phone: 718-866-4569
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number405995
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number714529-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: