Provider Demographics
NPI:1548492366
Name:SHARMA, JENNIFER ANNGROVE (MS CCC SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANNGROVE
Last Name:SHARMA
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:GROVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC SLP
Mailing Address - Street 1:182 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1811
Mailing Address - Country:US
Mailing Address - Phone:315-255-2746
Mailing Address - Fax:315-255-2740
Practice Address - Street 1:182 NORTH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1811
Practice Address - Country:US
Practice Address - Phone:315-255-2746
Practice Address - Fax:315-255-2740
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY020063-1OtherSTATE LICENSE NUMBER