Provider Demographics
NPI:1194951939
Name:PETERSON, SHARON ELIZABETH (MS, CCC/SLP-TSHH)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:ELIZABETH
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MS, CCC/SLP-TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 ROSS LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT SINAI
Mailing Address - State:NY
Mailing Address - Zip Code:11766-2521
Mailing Address - Country:US
Mailing Address - Phone:631-846-9162
Mailing Address - Fax:
Practice Address - Street 1:35 ROSS LN
Practice Address - Street 2:
Practice Address - City:MOUNT SINAI
Practice Address - State:NY
Practice Address - Zip Code:11766-2521
Practice Address - Country:US
Practice Address - Phone:631-846-9162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY09146154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist