MEDICARE: MS. TA SHARAE J. SOLOMON RN

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	163W00000X	Registered Nurse	557366-1	NY

General Provider Information

NPI Number	:	1184203507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TA SHARAE J. SOLOMON RN

Provider Business Mailing Address
First Line	:	6 FORDHAM HILL OVAL APT 7A
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10468-4827
Country	:	US
Telephone Number	:	718-484-0120
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 FORDHAM HILL OVAL APT 7A
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10468-4827
Country	:	US
Telephone Number	:	718-484-0120
Fax Number	:

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

Provider Enumeration Date	:	04/04/2021
Last Update Date	:	04/04/2021

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