Provider Demographics
NPI:1285701722
Name:GAVIN, SHARON K (AUD)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:K
Last Name:GAVIN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-4500
Mailing Address - Country:US
Mailing Address - Phone:914-631-1166
Mailing Address - Fax:
Practice Address - Street 1:200 S BROADWAY
Practice Address - Street 2:
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-4500
Practice Address - Country:US
Practice Address - Phone:914-631-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMOO381Medicare ID - Type Unspecified