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NPI Code Detail

MEDICARE: SHARLANE JORDAN

MEDICARE: SHARLANE JORDAN
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
1174400000XSpecialist1150617NY

General Provider Information

NPI Number : 1619832235
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHARLANE JORDAN
Provider Business Mailing Address
First Line : 1400 OLD COUNTRY RD STE C103N
Second Line :
City : WESTBURY
State : NY
Zip : 11590-5156
Country : US
Telephone Number : 516-806-6969
Fax Number : 516-806-5722
Provider Business Practice Location Address
First Line : 1400 OLD COUNTRY RD STE C103N
Second Line :
City : WESTBURY
State : NY
Zip : 11590-5156
Country : US
Telephone Number : 516-806-6969
Fax Number : 516-806-5722
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/16/2025
Last Update Date : 12/16/2025

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Directions to “ SHARLANE JORDAN ” Practice Location

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