Provider Demographics
NPI:1235454133
Name:DAWSON, SHARON ANN (RN, MHA)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:ANN
Last Name:DAWSON
Suffix:
Gender:F
Credentials:RN, MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5507 STATE ROUTE 89
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:NY
Mailing Address - Zip Code:14541-9756
Mailing Address - Country:US
Mailing Address - Phone:315-651-7469
Mailing Address - Fax:
Practice Address - Street 1:1330 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1173
Practice Address - Country:US
Practice Address - Phone:315-426-5956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-02
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1967-41101YM0800X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health