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General NPI Number Information
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NPI Number | 1487079125
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Entity Type | Individual
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Provider Name | SHARDE' MACK M.S
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Gender | Female
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Dates
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Enumeration Date | 03/04/2014
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Last Update Date | 03/05/2014
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Provider Practice Location Address
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Address Line | 82-68 164TH STREET
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City | QUEENS
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State | NY
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Zip | 11432-9630
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Country | US
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Telephone | 718-883-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 82-68 164TH STREET
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City | QUEENS
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State | NY
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Zip | 11432-9630
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Country | US
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Telephone | 718-883-3000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number |
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License Number State |
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