Provider Demographics
NPI:1902504053
Name:MOORE, SHARMANE DENISE (MD)
Entity Type:Individual
Prefix:PROF
First Name:SHARMANE
Middle Name:DENISE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:PROF
Other - First Name:ASIA
Other - Middle Name:
Other - Last Name:E
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:266 STATE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3117
Mailing Address - Country:US
Mailing Address - Phone:614-204-3584
Mailing Address - Fax:
Practice Address - Street 1:266 STATE ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3117
Practice Address - Country:US
Practice Address - Phone:614-204-3584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171000000XOther Service ProvidersMilitary Health Care ProviderGroup - Single Specialty