Provider Demographics
NPI:1215264403
Name:SHARP, CHE WHARTON (PT)
Entity type:Individual
Prefix:
First Name:CHE
Middle Name:WHARTON
Last Name:SHARP
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-2507
Mailing Address - Country:US
Mailing Address - Phone:845-339-6683
Mailing Address - Fax:845-339-7319
Practice Address - Street 1:107 GREENKILL AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-5441
Practice Address - Country:US
Practice Address - Phone:845-339-6683
Practice Address - Fax:845-339-7319
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021463-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist