Provider Demographics
NPI:1124343124
Name:FARRELL, SHARON BLAKENY (CRNP)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:BLAKENY
Last Name:FARRELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:34TH STREET & CIVIC CENTER BLVD
Mailing Address - Street 2:2ND FLOOR WOOD BUILDING
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:215-590-1527
Mailing Address - Fax:
Practice Address - Street 1:34TH STREET & CIVIC CENTER BLVD
Practice Address - Street 2:2ND FLOOR WOOD BUILDING
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-590-1527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010783363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics