Provider Demographics
NPI:1053052456
Name:SHARPE, MARISSA ANNE ANNE
Entity Type:Individual
Prefix:
First Name:MARISSA ANNE
Middle Name:ANNE
Last Name:SHARPE
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 1:1365 TRADE SQ W APT A
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-5014
Mailing Address - Country:US
Mailing Address - Phone:937-710-2502
Mailing Address - Fax:
Practice Address - Street 1:1365 TRADE SQ W APT A
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-5014
Practice Address - Country:US
Practice Address - Phone:937-710-2502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management