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General NPI Number Information
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NPI Number | 1942128749
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Entity Type | Individual
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Provider Name | SHARMA-SHANE FANTANA SERGEANT
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Gender | Male
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Dates
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Enumeration Date | 07/08/2026
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Last Update Date | 07/08/2026
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Provider Practice Location Address
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Address Line | 2927 DRIFTWOOD LN
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City | VINELAND
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State | NJ
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Zip | 08361-6739
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Country | US
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Telephone | 856-200-9574
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Fax |
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Provider Business Mailing Address
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Address Line | 2927 DRIFTWOOD LN
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City | VINELAND
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State | NJ
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Zip | 08361-6739
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Country | US
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Telephone | 856-200-9574
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 26NJ15591100
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License Number State | NJ
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