Provider Demographics
NPI:1427142322
Name:TRESTON-MAGNACCA, SHARON LYNNE (DPM)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:LYNNE
Last Name:TRESTON-MAGNACCA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 VIRGINIA DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-2131
Mailing Address - Country:US
Mailing Address - Phone:508-331-2378
Mailing Address - Fax:
Practice Address - Street 1:3 VIRGINIA DR
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2131
Practice Address - Country:US
Practice Address - Phone:508-331-2378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2103213ES0131X, 213EP1101X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY75115Medicare UPIN
MA5855560001Medicare NSC
MAY75115Medicare ID - Type Unspecified