Provider Demographics
NPI:1063713931
Name:EDMUNDSON, SHARON LYNN (MA)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:LYNN
Last Name:EDMUNDSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:LYNN
Other - Last Name:FRANCIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:8422 SW 4TH PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-1408
Mailing Address - Country:US
Mailing Address - Phone:352-332-5396
Mailing Address - Fax:352-505-6383
Practice Address - Street 1:5211 SW 91ST TER
Practice Address - Street 2:SUITE B
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-8128
Practice Address - Country:US
Practice Address - Phone:352-505-6363
Practice Address - Fax:352-505-6383
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA3802235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist