Provider Demographics
NPI:1588254510
Name:SHARP, PHYLLIS (CLC)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:SHARP
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:PHYLLIS
Other - Middle Name:R
Other - Last Name:SHARP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CLC
Mailing Address - Street 1:89 SELYE TER
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14613-1727
Mailing Address - Country:US
Mailing Address - Phone:585-820-5902
Mailing Address - Fax:
Practice Address - Street 1:89 SELYE TER
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14613-1727
Practice Address - Country:US
Practice Address - Phone:585-820-5902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-23
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY323980174N00000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RN