1134264880 NPI number — MS. SHARON ELAYNE VOLANSKY GERARD MA

Table of content: MS. SHARON ELAYNE VOLANSKY GERARD MA (NPI 1134264880)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134264880 NPI number — MS. SHARON ELAYNE VOLANSKY GERARD MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VOLANSKY GERARD
Provider First Name:
SHARON
Provider Middle Name:
ELAYNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA
Provider Gender Code:
F

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1134264880
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
90 BARROWS ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STOWE
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05672-4733
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-253-4674
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 MOSCOW ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOSCOW
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-253-2225
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/20/2007

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: 103T00000X , with the licence number:  0470000398 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 163W00000X , with the licence number: 0260012806 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 0009757 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1086657 . This is a "CIGNA" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 00005387 . This is a "BC BS" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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