1548492366 NPI number — JENNIFER ANNGROVE SHARMA MS CCC SLP

Table of content: JENNIFER ANNGROVE SHARMA MS CCC SLP (NPI 1548492366)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548492366 NPI number — JENNIFER ANNGROVE SHARMA MS CCC SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHARMA
Provider First Name:
JENNIFER
Provider Middle Name:
ANNGROVE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS CCC SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GROVE
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS CCC SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1548492366
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
182 NORTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUBURN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13021-1811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-255-2746
Provider Business Mailing Address Fax Number:
315-255-2740

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
182 NORTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13021-1811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-255-2746
Provider Business Practice Location Address Fax Number:
315-255-2740
Provider Enumeration Date:
08/12/2009

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: 235Z00000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 020063-1 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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