Healthcare Provider Details

I. General information

NPI: 1760965610
Provider Name (Legal Business Name): SHARI SEGALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 JEANNE MARIE GDNS APT F
NANUET NY
10954-1924
US

IV. Provider business mailing address

15 JEANNE MARIE GDNS APT F
NANUET NY
10954-1924
US

V. Phone/Fax

Practice location:
  • Phone: 845-642-5845
  • Fax:
Mailing address:
  • Phone: 845-642-5845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: