Provider Demographics
NPI:1144034075
Name:TATALO, SHARON ANN (MS)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:ANN
Last Name:TATALO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 HUNTINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02909-3056
Mailing Address - Country:US
Mailing Address - Phone:401-942-1450
Mailing Address - Fax:
Practice Address - Street 1:349 HUNTINGTON AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02909-3056
Practice Address - Country:US
Practice Address - Phone:401-942-1450
Practice Address - Fax:401-946-1550
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI201844101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)