Provider Demographics
NPI:1073768255
Name:SHARAN, GAYLE MADOFF (CCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:GAYLE
Middle Name:MADOFF
Last Name:SHARAN
Suffix:
Gender:F
Credentials:CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 LOWELL DR
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-5426
Mailing Address - Country:US
Mailing Address - Phone:914-906-8044
Mailing Address - Fax:845-639-0937
Practice Address - Street 1:37 LOWELL DR
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-5426
Practice Address - Country:US
Practice Address - Phone:914-906-8044
Practice Address - Fax:845-639-0937
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006277-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist