Healthcare Provider Details

I. General information

NPI: 1619832235
Provider Name (Legal Business Name): SHARLANE JORDAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 OLD COUNTRY RD STE C103N
WESTBURY NY
11590-5156
US

IV. Provider business mailing address

1400 OLD COUNTRY RD STE C103N
WESTBURY NY
11590-5156
US

V. Phone/Fax

Practice location:
  • Phone: 516-806-6969
  • Fax: 516-806-5722
Mailing address:
  • Phone: 516-806-6969
  • Fax: 516-806-5722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1150617
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: