MEDICARE: KATHERINE SHARP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant
2	363A00000X	Physician Assistant	026920	NY
3	363A00000X	Physician Assistant	25MP00647700	NJ

General Provider Information

NPI Number	:	1104464247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE SHARP

Provider Business Mailing Address
First Line	:	475 SEAVIEW AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-3436
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	645 HIGHWAY 18
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-3760
Country	:	US
Telephone Number	:	732-390-1190
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2019
Last Update Date	:	02/04/2025

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Directions to “ KATHERINE SHARP ” Practice Location

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