Provider Demographics
NPI:1902039035
Name:RESENDE, SHARA MARIE (MS, LAC, CA)
Entity Type:Individual
Prefix:MRS
First Name:SHARA
Middle Name:MARIE
Last Name:RESENDE
Suffix:
Gender:F
Credentials:MS, LAC, CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:95 E MAIN ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2158
Mailing Address - Country:US
Mailing Address - Phone:973-784-4273
Mailing Address - Fax:973-784-4274
Practice Address - Street 1:95 E MAIN ST
Practice Address - Street 2:SUITE 107
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2158
Practice Address - Country:US
Practice Address - Phone:973-784-4273
Practice Address - Fax:973-784-4274
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00068200171100000X
NY004099-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist