Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 182272 | NY |
Y | 2080A0000X | Adolescent Medicine | 182272 | NY |
NPI | 1124049713 |
---|---|
Provider Name | Sharon Edwards |
First Address | New York, NY 10128-5604 |
Second Address | New York, NY 10128-5604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 26/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F67H86 | (02) | NY |