1447869557 NPI number — SARAH JANE SHARPE MS, SLP-CCC

Table of content: SARAH JANE SHARPE MS, SLP-CCC (NPI 1447869557)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447869557 NPI number — SARAH JANE SHARPE MS, SLP-CCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHARPE
Provider First Name:
SARAH
Provider Middle Name:
JANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, SLP-CCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447869557
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
206 E 8TH ST SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROME
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30161-3316
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-696-7581
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6215 STONE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT RICHEY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34668-4847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-605-3060
Provider Business Practice Location Address Fax Number:
727-645-5215
Provider Enumeration Date:
07/24/2020

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 , with the licence number:  SLP009200 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 107469100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".