Provider Demographics
NPI:1053589234
Name:WOODWARD, SHARON ANN
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:ANN
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8137 VALLANCE RD
Mailing Address - Street 2:
Mailing Address - City:LE ROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482-9335
Mailing Address - Country:US
Mailing Address - Phone:585-768-7135
Mailing Address - Fax:
Practice Address - Street 1:8137 VALLANCE RD
Practice Address - Street 2:
Practice Address - City:LE ROY
Practice Address - State:NY
Practice Address - Zip Code:14482-9335
Practice Address - Country:US
Practice Address - Phone:585-768-7135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156419-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02070208OtherMEDICAID PROVIDER NUMBER