Provider Demographics
NPI:1720648306
Name:SHARER, KELLY PATRICIA
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:PATRICIA
Last Name:SHARER
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 1:4495 DONCASTER DR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-6798
Mailing Address - Country:US
Mailing Address - Phone:410-800-8616
Mailing Address - Fax:
Practice Address - Street 1:5530 WISCONSIN AVE STE 1135
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4459
Practice Address - Country:US
Practice Address - Phone:301-654-1666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist