Provider Demographics
NPI:1396160131
Name:FUSSELL, SHARON
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:FUSSELL
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 1:13601 OFFICE PL
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4213
Mailing Address - Country:US
Mailing Address - Phone:703-986-0429
Mailing Address - Fax:
Practice Address - Street 1:13601 OFFICE PL
Practice Address - Street 2:SUITE 104
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4213
Practice Address - Country:US
Practice Address - Phone:703-986-0429
Practice Address - Fax:703-590-4900
Is Sole Proprietor?:No
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019008639225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist