Provider Demographics
NPI:1174789887
Name:JACOBS, SHARI
Entity type:Individual
Prefix:
First Name:SHARI
Middle Name:
Last Name:JACOBS
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 1:14402 JEWEL AVE LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1744
Mailing Address - Country:US
Mailing Address - Phone:718-880-2050
Mailing Address - Fax:718-880-2052
Practice Address - Street 1:14402 JEWEL AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1744
Practice Address - Country:US
Practice Address - Phone:718-880-2050
Practice Address - Fax:718-880-2052
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215569208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty