Basic Information
| Provider Information | |||||||||
| NPI: | 1134382484 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCEVOY | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | SMITH | ||||||||
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| Credential: | RN, MA, NP-C, | ||||||||
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| Mailing Information | |||||||||
| Address1: | 847 N BROADWAY | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | MASSAPEQUA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117582373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167980441 | ||||||||
| FaxNumber: | 5167980445 | ||||||||
| Practice Location | |||||||||
| Address1: | 847 N BROADWAY | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | MASSAPEQUA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117582373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167980441 | ||||||||
| FaxNumber: | 5167980445 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2008 | ||||||||
| LastUpdateDate: | 04/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 304915 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.