MEDICARE: MRS. SHARON D DAISLEY CPNP

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	363LP0200X	Pediatric Nurse Practitioner	380106	NY

General Provider Information

NPI Number	:	1891839080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHARON D DAISLEY CPNP

Provider Business Mailing Address
First Line	:	4305 7TH AVE
Second Line	:	PS 169 ROOM #101
City	:	BROOKLYN
State	:	NY
Zip	:	11232-3954
Country	:	US
Telephone Number	:	718-854-6718
Fax Number	:	718-633-5414

Provider Business Practice Location Address
First Line	:	4305 7TH AVE
Second Line	:	PS 169 ROOM #101
City	:	BROOKLYN
State	:	NY
Zip	:	11232-3954
Country	:	US
Telephone Number	:	718-854-6718
Fax Number	:	718-633-5414

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

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	06/14/2011

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