Provider Demographics
NPI:1235172149
Name:BLACKMAN, SHARON I (BC-HIS,ACA)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:I
Last Name:BLACKMAN
Suffix:
Gender:F
Credentials:BC-HIS,ACA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2904 DAVID WALKER DR
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-6177
Mailing Address - Country:US
Mailing Address - Phone:352-589-4327
Mailing Address - Fax:352-589-0959
Practice Address - Street 1:2904 DAVID WALKER DR
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6177
Practice Address - Country:US
Practice Address - Phone:352-589-4327
Practice Address - Fax:352-589-0959
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS2776237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist