Healthcare Provider Details

I. General information

NPI: 1770859076
Provider Name (Legal Business Name): SHARON MAPP-DAVIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2127 HIMROD ST
RIDGEWOOD NY
11385-1234
US

IV. Provider business mailing address

203 HOLLY AVE
HEMPSTEAD NY
11550-5211
US

V. Phone/Fax

Practice location:
  • Phone: 718-381-9600
  • Fax: 718-381-9539
Mailing address:
  • Phone: 718-381-9600
  • Fax: 718-381-9539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number516698-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: