Provider Demographics
NPI:1487349346
Name:MOUZON, SHARITA M (LPN)
Entity type:Individual
Prefix:
First Name:SHARITA
Middle Name:M
Last Name:MOUZON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 OWASCO RD
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-4220
Mailing Address - Country:US
Mailing Address - Phone:516-250-3748
Mailing Address - Fax:
Practice Address - Street 1:1031 OWASCO RD
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-4220
Practice Address - Country:US
Practice Address - Phone:516-250-3748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY346828164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse