Active NPI
Shareatha Webster
- Peer Specialist
- North Haledon, NJ
National Provider Identifier
1790462539
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- CPRS-50440
- Practice address
- 11 Evergreen Ave
North Haledon, NJ 07508-2316 - Phone
- (732) 810-5510
- NPI assigned
- Jul 3, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | CPRS-50440 | NJ | Primary |
Addresses
Primary practice location
11 Evergreen Ave
North Haledon, NJ 07508-2316
Mailing address
11 Evergreen Ave
North Haledon, NJ 07508-2316
Phone (732) 810-5510
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CPRS-50440 | NJ | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1688342400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1688342400000",
"number": "1790462539",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 EVERGREEN AVE",
"city": "NORTH HALEDON",
"state": "NJ",
"postal_code": "075082316",
"telephone_number": "732-810-5510"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11 EVERGREEN AVE",
"city": "NORTH HALEDON",
"state": "NJ",
"postal_code": "075082316",
"telephone_number": "732-810-5510"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEBSTER",
"first_name": "SHAREATHA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-07-03",
"last_updated": "2023-07-03",
"certification_date": "2023-07-03",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "NJ",
"license": "CPRS-50440",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Haledon, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.