Provider Demographics
NPI:1124698535
Name:BURROW-MUMIN, SHARIS
Entity type:Individual
Prefix:
First Name:SHARIS
Middle Name:
Last Name:BURROW-MUMIN
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 1:308 HUNTERS FIELD CIR
Mailing Address - Street 2:
Mailing Address - City:CLAIRTON
Mailing Address - State:PA
Mailing Address - Zip Code:15025-5245
Mailing Address - Country:US
Mailing Address - Phone:610-659-0286
Mailing Address - Fax:
Practice Address - Street 1:308 HUNTERS FIELD CIR
Practice Address - Street 2:
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15025-5245
Practice Address - Country:US
Practice Address - Phone:610-659-0286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care