1063695138 NPI number — MS. SHARON LYNNE COSTA-SMITH M.S. ED

Table of content: MS. SHARON LYNNE COSTA-SMITH M.S. ED (NPI 1063695138)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063695138 NPI number — MS. SHARON LYNNE COSTA-SMITH M.S. ED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COSTA-SMITH
Provider First Name:
SHARON
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S. ED
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CABRAL
Provider Other First Name:
SHARON
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063695138
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 POSA PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DARTMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02747-2511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-996-3391
Provider Business Mailing Address Fax Number:
508-996-3397

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 POSA PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DARTMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02747-2511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-996-3391
Provider Business Practice Location Address Fax Number:
508-996-3397
Provider Enumeration Date:
12/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)