Provider Demographics
NPI:1013357235
Name:GRIFFIN, SHARON E (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:E
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 PENNSYLVANIA ST NE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7441
Mailing Address - Country:US
Mailing Address - Phone:505-254-3535
Mailing Address - Fax:
Practice Address - Street 1:1240 PENNSYLVANIA ST NE
Practice Address - Street 2:SUITE C
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7441
Practice Address - Country:US
Practice Address - Phone:505-254-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLN-0568133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist