Sharonda Nicole Clark, MD

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

25MA10947800 Issued in NJ

Practice address

30 Prospect Ave
Hackensack, NJ 07601-1915

Phone

(551) 996-4450

Fax

(551) 996-5729

NPI assigned

Oct 28, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• MCCD FL Psychiatry Services PA

  • Psychiatry Physician
  • Jacksonville, FL
  • NPI 1659003457
  NPD
• The University of Texas Southwestern Medical Center at Dallas

  • Clinical Medical Laboratory
  • Dallas, TX
  • NPI 1396832713
  NPD
• University of Texas Southwestern Medical Center at Dallas

  • Psychiatry Physician
  • Dallas, TX
  • NPI 1871563494
  NPD
• University of Texas Southwestern Medical Center at Dallas

  • Anesthesiology Physician
  • Dallas, TX
  • NPI 1942270566
  NPD
• Hackensack Meridian Health Medical Group - Complex Care PC

  • Internal Medicine Physician
  • Red Bank, NJ
  • NPI 1154379626
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1225152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607385600000",
    "number": "1487807145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14007 SUMMER ASH LN",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770445017",
            "telephone_number": "214-738-2265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 PROSPECT AVE",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076011915",
            "telephone_number": "551-996-4450",
            "fax_number": "551-996-5729"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "87 Route 17 North",
            "address_2": "Suite 1-118",
            "address_purpose": "LOCATION",
            "city": "Maywood",
            "state": "NJ",
            "postal_code": "07607",
            "country_code": "US",
            "telephone_number": "551-996-4450",
            "fax_number": "551-996-5729",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SHARONDA",
        "middle_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-28",
        "last_updated": "2020-12-08",
        "certification_date": "2020-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "TX",
            "license": "P1979",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NJ",
            "license": "25MA10947800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "080462703",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bernard C Ciongoli, D.O.
• City of Hackensack
• City of Hackensack Fire Department
• Elizabeth Clanaman
• Eleanor Ann Clark II, BA, CADC
• Nadine Clarke-Bailey
• Praeophayom Clarke, MD
• Briana Joy Clauss, DC
• Katharine N Clouser, M.D.
• Carly Gerogia Cobbol, DO

• Child & Adolescent Psychiatry Physician in Hackensack, NJ
• Providers in Hackensack, NJ by specialty
• Child & Adolescent Psychiatry Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.