Provider Demographics
NPI:1124339718
Name:ESDALE, SHARON (LIC AC)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:ESDALE
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 SOUTHAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:WESTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-9538
Mailing Address - Country:US
Mailing Address - Phone:413-341-7151
Mailing Address - Fax:
Practice Address - Street 1:39 MAIN ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3578
Practice Address - Country:US
Practice Address - Phone:413-341-7151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0910047356171100000X
MA245948171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist