Provider Demographics
NPI:1194360073
Name:RODRIGUES, SHARONN BOATO (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:SHARONN
Middle Name:BOATO
Last Name:RODRIGUES
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:MRS
Other - First Name:SHARONN
Other - Middle Name:BOATO
Other - Last Name:RODRIGUES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MASSAGE THERAPIST
Mailing Address - Street 1:207 RIDGELY AVE
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1379
Mailing Address - Country:US
Mailing Address - Phone:443-788-1581
Mailing Address - Fax:
Practice Address - Street 1:207 RIDGELY AVE
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1379
Practice Address - Country:US
Practice Address - Phone:443-788-1581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR01549225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist