Provider Demographics
NPI:1679307896
Name:WATERS, SHARON DENISE
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:DENISE
Last Name:WATERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:DENISE
Other - Last Name:BERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:45610 TOWNSHIP ROAD 2313
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43754-9515
Mailing Address - Country:US
Mailing Address - Phone:803-493-2399
Mailing Address - Fax:
Practice Address - Street 1:45610 TOWNSHIP ROAD 2313
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:OH
Practice Address - Zip Code:43754-9515
Practice Address - Country:US
Practice Address - Phone:803-493-2399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant