Provider Demographics
NPI:1588410146
Name:MALCOLM-MILLER, SHARON (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:
Last Name:MALCOLM-MILLER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 WINGATE RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-2947
Mailing Address - Country:US
Mailing Address - Phone:516-569-0976
Mailing Address - Fax:
Practice Address - Street 1:3815 PUTNAM AVE W
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-2442
Practice Address - Country:US
Practice Address - Phone:718-549-7260
Practice Address - Fax:718-549-7177
Is Sole Proprietor?:No
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF311443-01363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health