Basic Information
| Provider Information | |||||||||
| NPI: | 1174566889 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHARPE | ||||||||
| FirstName: | TRACY | ||||||||
| MiddleName: | MARGARET | ||||||||
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| Credential: | RD CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 WATER STREET 12TH FLOOR CRED DEPT | ||||||||
| Address2: | ADVANTAGECARE PHYSICIANS, PC | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100410004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188265911 | ||||||||
| FaxNumber: | 7188265860 | ||||||||
| Practice Location | |||||||||
| Address1: | 546 EASTERN PARKWAY | ||||||||
| Address2: | EMPIRE CENTER | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186044800 | ||||||||
| FaxNumber: | 7186044828 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 01/31/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133N00000X | 0023631 | NY | Y | Dietary & Nutritional Service Providers | Nutritionist |
No ID Information.