Provider Demographics
NPI:1164969184
Name:MIDURA, SHARON (BCBA)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:MIDURA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20677 S WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-3009
Mailing Address - Country:US
Mailing Address - Phone:216-990-4492
Mailing Address - Fax:
Practice Address - Street 1:8848 COMMONS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-6808
Practice Address - Country:US
Practice Address - Phone:330-405-8776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-28
Last Update Date:2017-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11624597103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst