Provider Demographics
NPI:1730337502
Name:FLYNN, SHARON (RD)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:FLYNN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:
Other - Last Name:DOCARMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23 STONE HILL RD
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-2621
Mailing Address - Country:US
Mailing Address - Phone:973-598-0160
Mailing Address - Fax:
Practice Address - Street 1:769 NORTHFIELD AVE
Practice Address - Street 2:CKD SERVICES OF W. ORANGE STE. LL4
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1198
Practice Address - Country:US
Practice Address - Phone:973-669-8574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJR801369133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal