Healthcare Provider Details

I. General information

NPI: 1124049713
Provider Name (Legal Business Name): SHARON EDWARDS M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 03/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 E 94TH ST
NEW YORK NY
10128-5604
US

IV. Provider business mailing address

312 E 94TH ST
NEW YORK NY
10128-5604
US

V. Phone/Fax

Practice location:
  • Phone: 212-423-2900
  • Fax: 212-423-2920
Mailing address:
  • Phone: 212-423-2900
  • Fax: 212-423-2920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number182272-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number182272
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number182272
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: