Basic Information
| Provider Information | |||||||||
| NPI: | 1124230198 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAY | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | LOIS | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | NPP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KOZAKIEWICZ | ||||||||
| OtherFirstName: | SHARON | ||||||||
| OtherMiddleName: | LOIS | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | NPP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 57 MINER RD | ||||||||
| Address2: | |||||||||
| City: | PORTER CORNERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128591702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185843600 | ||||||||
| FaxNumber: | 5185812535 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 CRESCENT AVE | ||||||||
| Address2: | |||||||||
| City: | SARATOGA SPRINGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128665142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185843600 | ||||||||
| FaxNumber: | 5185812535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | F400623 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.