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General NPI Number Information
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NPI Number | 1902713696
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Entity Type | Individual
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Provider Name | SHARON NICOLE PROVISIERO FNP
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Gender | Female
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Dates
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Enumeration Date | 08/26/2026
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Last Update Date | 08/26/2026
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Provider Practice Location Address
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Address Line | 90 E MAIN ST STE I
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City | PATCHOGUE
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State | NY
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Zip | 11772-3176
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Country | US
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Telephone | 631-208-6514
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Fax |
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Provider Business Mailing Address
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Address Line | 1843 WISTERIA CIR
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City | BELLPORT
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State | NY
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Zip | 11713-3057
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Country | US
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Telephone | 631-208-6514
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | F360353-01
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License Number State | NY
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