Provider Demographics
NPI:1295209138
Name:LEE, SHARON SUYON
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:SUYON
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4115 ANNANDALE RD STE 308
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2500
Mailing Address - Country:US
Mailing Address - Phone:703-354-9111
Mailing Address - Fax:
Practice Address - Street 1:4115 ANNANDALE RD STE 308
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2500
Practice Address - Country:US
Practice Address - Phone:703-354-9111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-2037374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty