Provider Demographics
NPI:1801650387
Name:THACHERIL, SHARON ELIZABETH
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:ELIZABETH
Last Name:THACHERIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1787 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-2628
Mailing Address - Country:US
Mailing Address - Phone:914-310-9910
Mailing Address - Fax:
Practice Address - Street 1:1787 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NORTH BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-2628
Practice Address - Country:US
Practice Address - Phone:914-310-9910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF421682363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health