Healthcare Provider Details

I. General information

NPI: 1518111475
Provider Name (Legal Business Name): SHARRILL JEANNETTE SCOLARO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 57TH ST STE 307
NEW YORK NY
10019-3211
US

IV. Provider business mailing address

200 W 57TH ST STE 307
NEW YORK NY
10019-3211
US

V. Phone/Fax

Practice location:
  • Phone: 917-410-6905
  • Fax: 646-878-6095
Mailing address:
  • Phone: 917-410-6905
  • Fax: 646-878-6095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number012746
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: