Provider Demographics
NPI:1962619593
Name:SHARON JOLLY & ASSOCIATES, LLC
Entity type:Organization
Organization Name:SHARON JOLLY & ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC SLP A
Authorized Official - Phone:845-928-2579
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:CENTRAL VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10917-0368
Mailing Address - Country:US
Mailing Address - Phone:845-928-2579
Mailing Address - Fax:845-928-2729
Practice Address - Street 1:450 GIDNEY AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3116
Practice Address - Country:US
Practice Address - Phone:845-928-2579
Practice Address - Fax:845-928-2729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWYQQW1Medicare PIN