Provider Demographics
NPI:1962187310
Name:SHARP, SCANLON JR
Entity type:Individual
Prefix:
First Name:SCANLON
Middle Name:
Last Name:SHARP
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 E 36TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-3007
Mailing Address - Country:US
Mailing Address - Phone:216-551-7094
Mailing Address - Fax:
Practice Address - Street 1:2304 E 36TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3007
Practice Address - Country:US
Practice Address - Phone:216-551-7094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports