Provider Demographics
NPI:1285201780
Name:RUS, SHARON R (MA, CF-SLP, TSSLD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:R
Last Name:RUS
Suffix:
Gender:F
Credentials:MA, CF-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 LORRAINE CT
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-1633
Mailing Address - Country:US
Mailing Address - Phone:631-813-8557
Mailing Address - Fax:
Practice Address - Street 1:7 LORRAINE CT
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-1633
Practice Address - Country:US
Practice Address - Phone:631-813-8557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program