Provider Demographics
NPI:1194172072
Name:WELLMAN, SHARON
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:WELLMAN
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 1:295 SANDY DOWDY RD
Mailing Address - Street 2:
Mailing Address - City:GOLDSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27252-9623
Mailing Address - Country:US
Mailing Address - Phone:919-898-4345
Mailing Address - Fax:
Practice Address - Street 1:295 SANDY DOWDY RD
Practice Address - Street 2:
Practice Address - City:GOLDSTON
Practice Address - State:NC
Practice Address - Zip Code:27252-9623
Practice Address - Country:US
Practice Address - Phone:919-898-4345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC408160251C00000X, 251E00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC408160Medicaid