Provider Demographics
NPI:1386253292
Name:SHARPSTEEN, CARLY JOY
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:JOY
Last Name:SHARPSTEEN
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 1:979 SILVER SPRINGS TER NW
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-3745
Mailing Address - Country:US
Mailing Address - Phone:954-682-5603
Mailing Address - Fax:
Practice Address - Street 1:2500 BOBCAT VILLAGE CENTER RD UNIT G
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34288-8476
Practice Address - Country:US
Practice Address - Phone:800-217-9289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician