Provider Demographics
NPI:1679626295
Name:BROOKS, SHARON MERDELLA (FNP)
Entity type:Individual
Prefix:MISS
First Name:SHARON
Middle Name:MERDELLA
Last Name:BROOKS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6427 24TH PL
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-1746
Mailing Address - Country:US
Mailing Address - Phone:301-559-6903
Mailing Address - Fax:
Practice Address - Street 1:6085 MARSHALEE DR
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6023
Practice Address - Country:US
Practice Address - Phone:240-417-9992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR092137363LF0000X
DCRN48813363LF0000X
DELG-0000387363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily